For many Nigerians without health insurance, a serious illness does not only threaten their health, it can threaten their financial stability, forcing families to dip into savings, sell assets or borrow money to pay for treatment. Funmi Ogundare and Ayodeji Ake examine how the absence of adequate health insurance can leave households vulnerable to the devastating economic consequences of illness Sadiq Adedeji is swimming in debt. For one young Lagos-based vulcaniser, life seemed to be going according to plan. He was young, working and making money. He saved from what he earned, lived within his means and, by his own standards, was comfortable. There was no major medical emergency hanging over his household, so health insurance did not appear to him to be an urgent necessity. After he got married, however, people around him advised him to consider taking a health insurance plan. However, he declined. Like many people who postpone insurance until illness strikes, he believed that if a medical challenge came, he would find a way to deal with it. Adedeji’s first major financial shock came when his aged father needed eye surgery. Because nobody in the family had health insurance, the responsibility for the medical bills fell directly on him. He had to pay from his pocket for the surgery, as well as the medical care before and after the procedure. The savings he had carefully accumulated began to disappear. At the same time, his wife was pregnant. What followed turned an ordinary family expense into a devastating financial crisis. As the pregnancy progressed into the third trimester, his wife developed health complications. The young man, already financially weakened by his father’s treatment, had to find more money for medical care. His savings were no longer enough. He borrowed from friends and relatives. He also turned to loan sharks. The more medical bills came, the more debt accumulated. Eventually, his wife needed a Caesarean section. Once again, he had to scramble for money, borrowing from different sources while already struggling under the weight of previous debts. Then came the tragedy no family should have to experience. His wife gave birth, but the baby was stillborn. Adedeji was left facing two devastating realities at once: the loss of his child and a mountain of debt accumulated in the attempt to pay for medical care. His experience captures a problem that often receives less attention in discussions about healthcare; a medical crisis can become a financial crisis. It is a reality health insurance is designed, at least in part, to address. Health insurance cannot guarantee that a patient will survive a serious illness. It cannot guarantee that every pregnancy complication will have a positive outcome. But having health insurance can reduce the extent to which families have to pay for covered healthcare entirely out of pocket when unexpected medical needs arise. That is the financial protection at the centre of Lagos State’s push for compulsory social health insurance. Under Executive Order number EO/BOS/01 of 2024, the state government made enrolment in social health insurance compulsory for residents and workers in the state. The implementation is being carried out in phases, with enforcement activities formally commencing in 2026. For the Lagos State Health Management Agency (LASHMA), with its ILERA EKO initiative, the objective is not simply to create another government programme. It is to ensure that residents have a mechanism for accessing healthcare without being left financially devastated when illness occurs. The agency said the scheme is designed to protect residents from catastrophic health expenditure, promote access to quality and affordable healthcare, and encourage shared responsibility in financing healthcare. LASHMA also describes the scheme as providing ‘peace of mind’ by making medical expenditure more predictable and protecting households from the financial hardship associated with huge medical bills. Making health insurance understood But while the government may make insurance compulsory, another challenge remains: getting residents to understand why they need it and how to use it. That challenge was at the centre of a two-day capacity-building programme organised by LASHMA for journalists on the Lagos State health scheme and the mandatory social health insurance programme, known as ILERA EKO. The Permanent Secretary of LASHMA, Dr. Emmanuella Zamba, urged journalists to take the lead in educating residents on the benefits of health insurance, saying effective public communication was critical to achieving universal health coverage in Lagos. “Policies alone do not guarantee success, their effectiveness depends on understanding, cooperation and participation,” Zamba said. She ex
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