Barrister Olaedo Obasi and Barrister Chisom Ezeh
Department of Public administration, Federal Polytechnic, Oko.
Corresponding Author’s email: yanwithola@yahoo.com
Abstract
In an effort to achieve universal healthcare access, the Nigerian government enacted the Social
Health Insurance (SHI) policy in 1999. Supported by the World Health Organization in 2005,
SHI aims to enhance healthcare access for the nation’s most vulnerable populations through
resource risk pooling. The National Health Insurance Scheme was established to regulate and
implement this policy as part of broader healthcare reforms. Despite these initiatives, the SHI
policy in Nigeria has experienced slow uptake and limited coverage, hindering the
government’s goal of comprehensive population coverage. This dissertation analyzes the
implementation of SHI in Nigeria through a theoretical review, utilizing secondary literature
to develop a conceptual framework grounded in key theories: Solidarity and Risk Sharing,
Social Capital, Social Mobilization, and Social Contract. The analysis identifies several
challenges, including insufficient political will, lack of fiscal commitment, socioeconomic and
institutional barriers, as well as cultural and religious beliefs affecting individual participation.
Drawing on these theoretical frameworks, the study offers recommendations such as
mandatory insurance contributions, the establishment of vulnerable group funds, subsidy gap
funding, enhanced state and community resource pooling, and increased education and
advocacy efforts at the rural level. It also emphasizes the need for greater collaboration among
government agencies and calls for research into the barriers contributing to low enrollment in
SHI.