By Ireti Asemota
The Lagos State Health Insurance Scheme, popularly known as Ilera Eko, was launched in 2018 to expand universal health coverage, reduce catastrophic out-of-pocket spending, and guarantee access to affordable healthcare for all residents. But findings by PUNCH Healthwise show that many enrollees are still paying huge medical bills at state-owned hospitals despite being fully registered under the scheme.
Promises of coverage but crippling bills
When Bosun Aderinoku enrolled in Ilera Eko six months ago, he believed the scheme would protect his pregnant wife from overwhelming delivery expenses. He was assured that both vaginal delivery and caesarean section (CS) were covered.
But on October 22, 2025, when his wife needed an emergency CS at Gbagada General Hospital, nurses asked him to buy consumables and drugs out-of-pocket. Despite informing the pharmacy he was under LASHMA, he received only a fraction of the items needed and was forced to pay for the rest — spending over N115,000 before surgery began.
Six days later, he received another bill of N294,000. When he complained to LASHMA, officials told him the free CS package was no longer available under his registration category, leaving him devastated.
‘Approval denied’ — another family pushed into debt
Like Aderinoku, Temitope Usman believed Ilera Eko would provide financial relief when his wife went into labour after months of antenatal care covered by LASHMA. But when labour stalled and an emergency CS became necessary, nurses insisted he buy consumables because waiting for LASHMA approval “would take time.”
Usman spent almost all his savings buying gloves, syringes, theatre packs, antibiotics, drips and more. After delivery, he expected the bill to be settled through the scheme — only to learn that LASHMA rejected the claim entirely. Despite the consultant gynaecologist intervening with a medical justification, the agency maintained that policy changes had removed coverage for the procedure.
“I enrolled so I wouldn’t have to beg when my wife delivered. Now I am in debt,” he lamented.
A scheme meant to protect the vulnerable
Established through a 2015 law and launched in 2018, Ilera Eko was celebrated as Lagos’ pathway to universal health coverage, ensuring affordable care for all residents regardless of income. The plan initially covered maternity care, surgeries, laboratory tests, outpatient care, and emergency procedures at minimal or no extra cost.
By September 2025, over 1.3 million Lagos residents were enrolled.
Policy changes leave enrollees stranded
Investigations revealed that policy adjustments introduced quietly in mid-2025 have significantly reduced benefits. Enrollees now encounter:
-
Requests for prior approval before procedures
-
Increased rejection of previously covered claims
-
Unexpected partial or full payment requirements, especially for maternal and emergency care
Health workers say they are no longer sure what LASHMA covers.
A midwife explained:
“We used to know CS and emergency care were covered. Now we don’t even know what to tell patients.”
Experts raise concerns
Health experts warn that these rising out-of-pocket payments undermine the goal of universal health coverage and may worsen Nigeria’s already high maternal mortality rate.
Health economist Dr. Ifeoma Okonkwo said the new policies harm the most vulnerable, especially those who enroll late in pregnancy or need urgent care.
“If promised benefits suddenly disappear, people lose trust. Prepaid health coverage becomes meaningless,” she said.
Consultant gynaecologist Prof. Ernest Orji also stressed that expensive out-of-pocket payments remain a major driver of maternal deaths in Nigeria.
