WHO, NHIA Push for Integration of HIV, TB, Malaria Services into State Health Insurance Schemes

By Ojoma Akor

The World Health Organization (WHO), the National Health Insurance Authority (NHIA), and health policy experts have called for integrating HIV, tuberculosis (TB), and malaria services into state health insurance schemes to expand healthcare access and advance universal health coverage in Nigeria.

The call came at a validation workshop for a handbook designed to guide state health insurance agencies in integrating services for people living with HIV, TB and malaria into existing social health insurance arrangements.

The initiative, supported by the Global Fund, is being implemented as a pilot program across five states, and the handbook is expected to document lessons from the process and provide practical guidance for other states seeking to adopt the approach.

Speaking at the workshop, Dr Mary Brantuo, Team Lead, Strategic Health Policy and Planning at WHO, said documenting the experiences of participating states was critical to strengthening technical assistance and supporting the program’s nationwide expansion.

Brantuo explained that one of Nigeria’s major challenges in achieving universal health coverage remained the low number of people enrolled in health insurance schemes.

She said the integration of vulnerable populations, particularly people living with HIV, TB and malaria, into state social health insurance schemes offered an opportunity to improve access to healthcare while building on existing government-led insurance structures.

According to her, the handbook would capture lessons from participating states and provide step-by-step guidance for other states seeking to replicate the approach.

She noted that although states operate within different social, cultural, and economic contexts, documenting their experiences would help identify common implementation challenges and possible solutions.

Brantuo said barriers such as cultural beliefs, misconceptions, and other community-specific factors could affect enrolment and utilization of health insurance services, making it necessary for states to understand their local contexts when implementing the program.

She emphasized that the initiative was not intended to benefit only people affected by the three diseases but should serve as an entry point to expand insurance coverage to the wider population.

“Our key message is that each of us has to be insured because we do not know when we will fall ill. We cannot wait until we fall ill before looking for money or selling our belongings to access healthcare,” she said.

She urged Nigerians to enroll in their respective state social health insurance schemes, stressing that prepayment through insurance would reduce financial barriers to accessing healthcare.

Dr Charles Ohuakanwa

Also speaking, Dr Charles Ohuakanwa, Head of Planning, Research and Statistics at the NHIA, said the authority was central to implementing the Global Fund-supported program and was working with partners to strengthen the integration model ahead of its expansion.

He explained that the pilot was designed to cover vulnerable populations, particularly people living with HIV and TB, while the lessons gathered would provide a foundation for onboarding additional states in subsequent implementation phases.

Ohuakanwa said the validation workshop was important for documenting implementation experiences and identifying areas for improvement before the program was scaled up.

He noted that the broader objective of the NHIA remained ensuring that every Nigerian had access to affordable and equitable healthcare without suffering financial hardship.

On eligibility, he explained that people diagnosed with TB and HIV were considered vulnerable populations under the program. He also identified access to primary healthcare facilities as another potential entry point for identifying vulnerable individuals who could benefit from health insurance coverage.

Meanwhile, Professor Obinna Onwujekwe, Director of the Health Policy Research Group at the University of Nigeria, Nsukka, said integrating disease-specific interventions into existing health insurance systems would reduce inefficiencies, improve resource utilization and make healthcare financing more sustainable.

Onwujekwe, whose organization has advanced universal health coverage in Nigeria since 2014, said the handbook was developed through a co-creation process involving state representatives rather than being produced solely by technical experts.

He explained that an assessment informed the handbook’s development, while consultations with states helped ensure its recommendations reflected practical implementation realities.

According to him, the validation exercise would allow states to identify gaps, strengthen the document and agree on the activities and capacity-building requirements needed for effective implementation.

He urged states to adopt integration as a sustainable approach to healthcare financing, noting that embedding disease-specific interventions within existing insurance schemes could help governments reach more vulnerable populations without depending indefinitely on donor funding.

“Integration is the way to go because when we integrate into what exists, we can bring more people in and cover a lot of vulnerable people without needing to depend on donor funding,” he said.

Sharing the experience of an implementing state, Dr Augustine Ezeka, Executive Secretary of the Anambra State Health Insurance Agency, described the Global Fund partnership as instrumental in expanding access to healthcare for people living with HIV and TB.

He said that over the 24 months of collaboration with Anambra State, the program had provided free medical services to beneficiaries enrolled through the state insurance agency.

Ezeka said beneficiaries could access treatment for various health conditions at designated healthcare facilities without paying out of pocket, provided they had been confirmed to be living with HIV or had TB and were registered under the state insurance scheme.

He said the handbook was particularly important in preparing state insurance agencies for the gradual withdrawal of international development partners by helping them develop locally driven mechanisms to sustain the program.

According to him, the objective is to ensure that beneficiaries continue to receive comprehensive healthcare services regardless of whether external partners remain involved.

The handbook is expected to provide states with practical implementation guidance, identify capacity gaps, and strengthen the institutional arrangements needed to integrate the program into existing state health insurance frameworks.

Stakeholders said the initiative’s long-term success would depend on state ownership, adequate financing, institutional capacity, and sustained political commitment.

They stressed that expanding health insurance coverage beyond donor-supported disease programs would be critical to Nigeria’s progress towards universal health coverage, where everyone can access quality healthcare when needed without suffering financial hardship.