In a city where a single medical emergency can drain a family’s life savings, Lagos is intensifying efforts to ensure that healthcare no longer depends on the size of a wallet.
At the forefront of that effort is the Lagos State Health Management Agency (LASHMA), the agency driving the state’s social health insurance programme, Ilera Eko. With 1.3 million residents already enrolled, the government is now moving from persuasion to enforcement — starting with its own workforce.
Beginning with April salary payments, enrollment in Ilera Eko will be enforced for public servants, following a directive from the Office of the Head of Service. The move is designed to ensure that government workers lead by example under the state’s mandatory health insurance policy.
“We cannot declare health insurance compulsory and exclude ourselves,” Permanent Secretary of LASHMA, Dr. Emanuela Zamba, said at the close of a two-day capacity-building workshop for journalists in Ikeja. “Registration is ongoing, and cooperation has been very good so far.”
At the workshop, the government recognised that partnership would be required to ensure residents understand the importance of protection against financing ailment.
Recognising the power of information in shaping public behaviour, LASHMA convened dozens of health writers for the training in collaboration with the International Society of Media in Public Health (ISMPH) and Engender Health, to equip journalists with accurate data and deepen their understanding of the Lagos State Health Scheme, positioning them as partners in promoting transparency and accountability.
During the workshop, the participants were informed that the mandatory health insurance enrolment for Lagos residents came into force following an Executive Order signed on July 16, 2024, by Governor Babajide Sanwo-Olu mandating health insurance coverage for all Lagos residents.
For public servants, the state government is covering 75 per cent of the annual premium, while employees contribute the remaining 25 per cent.
In addition, one per cent of the state’s Consolidated Revenue Fund has been dedicated to an Equity Fund that provides coverage for vulnerable residents. That fund was recently increased from ₦1 billion to ₦3 billion and approved as a first-line charge.
The broader goal is universal health coverage — ensuring that no Lagosian is pushed into poverty by hospital bills.
Out-of-pocket health expenses remain a major challenge in Nigeria. A caesarean section, for instance, can cost between ₦500,000 and ₦1 million in some facilities. Under Ilera Eko, enrolled mothers can access heavily subsidised or free procedures.
The benefits package also includes surgeries, medications, diagnostic tests, and treatment for chronic conditions such as hypertension.
Zamba stressed that the scheme’s strong emphasis on maternal and child health is aimed at reducing preventable deaths and protecting households from catastrophic expenses.
“In a megacity like Lagos, health insurance is no longer optional — it is essential,” she said.
For regulators, the logic of enforcement is simple: insurance thrives on participation.
The Coordinator of Regulations at LASHMA,. Tosin Awosika, explained that many public servants already covered under employer-funded plans have yet to activate their enrollment under Ilera Eko. Bringing them fully into the system will expand the financial pool needed to strengthen healthcare delivery.
“Insurance works based on numbers,” he said. “The larger the pool, the more resources are available to treat everyone and reduce out-of-pocket expenses.”
A larger pool, he added, will help finance infrastructure upgrades, equipment purchases, and personnel training — while enabling the state to expand benefits over time and extend coverage to more vulnerable groups.
According to programme data presented by the monitoring and evaluation officer for LASHMA, Kehinde Daodu, Ilera Eko has grown steadily since inception, recording an average annual growth rate of 27 per cent. As of June 4, 2025, enrollment had reached 1.3 million beneficiaries — a figure projected to grow by between 50 and 100 per cent annually as mandatory coverage takes effect.
Women make up a slight majority of enrollees, while men account for 47 per cent. The working-age population represents 61 per cent of subscribers, followed by children aged five to 18 at 25 per cent. Children under five account for four per cent, and persons over 60 make up 10 per cent.
Despite the progress, officials acknowledge that many residents remain outside the insurance net — underscoring the need for sustained public awareness.
Reiterating Lagos officials’ stance that enforcement alone will not guarantee success. Education, engagement, and public confidence remain central to the scheme’s sustainability. Zamba stressed that the message is simple: health insurance is not merely a policy directive — it is a social contract.
By expanding enrollment, strengthening financial protection, and investing in healthcare infrastructure, the state hopes to build a system where quality care is accessible to all — not just the few who can afford it.
If the momentum continues, Ilera Eko could redefine how Africa’s most populous city finances healthcare, turning solidarity into a safety net for millions.
Earlier, the Executive Director of ISMPH, Moji Makanjuola, urged reporters to use their platforms to elevate evidence-based conversations around health insurance, primary healthcare funding, and equitable access for underserved communities.
Clear and consistent reporting, she noted, can build public trust and ensure that healthcare investments are transparently managed.
