HEALTHCARE FINANCING UNDER NIGERIA‟S NATIONAL HEALTH INSURANCE ACT (NHIA): IMPLICATIONS FOR PERSONS LIVING WITH NON- COMMUNICABLE DISEASES IN NIGERIA

Abstract

Nigeria‘s rising burden of chronic non-communicable diseases (NCDs) presents a fundamental challenge to the healthcare financing system under the National Health Insurance Act (NHIA). While the NHIA aspires to advance universal health coverage, its financing design remains largely oriented towards episodic and curative care, offering limited protection for persons living with chronic NCDs who require continuous, preventive and long-term treatment. This article demonstrates that the existing healthcare financing framework under the NHIA is structurally inadequate to secure health security and financial protection for persons living with chronic NCDs, thereby reinforcing health-related impoverishment and inequity. Drawing on the capabilities approach, the article reconceptualizes healthcare financing not merely as access to services, but as a legal and institutional mechanism for enabling full functioning and sustained well-being. Using the universal health coverage pillars of equity, access and coverage as an evaluative yardstick, the article interrogates the NHIA‘s benefit package, cost-sharing arrangements and regulatory design to expose critical gaps in chronic disease financing. It argues that the current framework insufficiently addresses the social and economic determinants of NCDs, including preventive interventions linked to unhealthy diets, and fails to mitigate the vicious cycle between chronic illness and poverty. The article contributes to Nigerian health law scholarship by advancing a capabilities-based critique of the NHIA and proposing targeted regulatory and financing reforms aimed at reducing financial hardship, improving continuity of care, and enhancing functional health outcomes for persons living with chronic NCDs.