Technology Review of the Nigerian National Health Insurance Authority: Gaps and Strategic Digital Interventions

Abstract

The National Health Insurance Authority (NHIA) Act of 2022, which replace the Nigeria’s National Health Insurance Scheme (NHIS) as the country’s health insurance system, represents a significant paradigm shift in the quest for Universal Health Coverage (UHC). However, Nigerians are yet to fully tap the intended benefits of the scheme due to existing operational and technological limitations. This paper presents a system analysis report of the technology adoption of the scheme adopting a system analysis and design methodology to software engineering. In this approach, an extensive operational and technological system study of the NHIA scheme was conducted. Interviews, record review, and physical inspection of operational processes were used to gather information. Records show that basic gaps exist in data integration, interoperability, claims processing, and service provider monitoring which has greatly impacted on the effective delivery of the scheme leading to revenue leakage, poor access to healthcare, inadequate healthcare delivery, and poor record system. This paper therefore presents a proposal design which is a locally tailored digital framework; robust, optimise operations, minimise revenue leakage, and scale health equity across Nigeria. The proposed design address existing technological and operational gaps which will be implemented to provide a National Health Information Management Framework based on a National Electronic Health Record (EHR) platform that is centralised and capable of providing an improved health outcome and enrollee experience.