POLICY IMPLEMENTATION AND BUREAUCRATIC BOTTLENECKS IN NIGERIA: EXAMINING THE EFFECTIVENESS OF THE NATIONAL HEALTH INSURANCE AUTHORITY (NHIA)
Dr. Bassey Moses Ogar Senior Lecturer, Department Of International Relations Institute Of Arts Management & Professional Studies, Nigeria Basseymoses2k24@gmail.com
Volume 5, Issue 1, March 2025
This study examined the policy implementation and bureaucratic bottlenecks that affected Nigeria's National Health Insurance Authority (NHIA). The study sought to determine whether a change from the NHIS to the NHIA could address the deficiencies of the previous healthcare system and open the way to UHC. In this study, a qualitative research approach was used, and the data were obtained from policy documents, interviews, and surveys from the NHIA officials, other managers, front-line providers, beneficiaries and a study from the healthcare providers. Enrollment statistics revealed that the NHIA status went up from 18% in 2019 to an expected 38% in 2023; claim reimbursement averaged 45 days in the previous years, reduced to 30 days in this study; beneficiary satisfaction rating also rose from 3.2 to 4.1 on a scale 1 to 5. The thematic analysis indicates that bureaucratic delays, corruption, implementation fragmentation across states, and technological limitations hindered the fair operation of the NHIA. Further case study support established the positive influence of better management and political will in the Kaduna State pilot. In contrast, the late and poor enrollment of remaining states, such as Plateau, consistently stagnated through inefficiency and graft, creating irregularities in enrollment. When comparing Ghana's NHIS, Rwanda's CBHI, and the UK's NHS, bureaucratic problems and accountability were significant issues evident, as this research found out. At the same time, the NHIA has made significant achievements in addressing delays and developing and engaging with stakeholders; further legal, fiscal, and administrative restructuring was required to guarantee NHIS of all Nigerians in the future.