In a bid to expand access to affordable healthcare, the Lagos State Government has moved to enforce compulsory health insurance at primary healthcare centres, urging district leaders to champion the policy.
The Permanent Secretary, Lagos State Health Management Agency (LASHMA), Dr. Emmanuella Zamba disclosed this at the engagement held recently in Ikeja, with Permanent Secretaries of the six Health Districts, Directors of Medical Services (DMS), and Medical Officers of Health (MOHs) from Local Government Areas (LGAs) and Local Council Development Areas (LCDAs), with a focus on strengthening enrolment and compliance at Primary Healthcare Centres (PHCs).
Addressing participants, Zamba, described the meeting as a deliberate effort to deepen compliance and translate policy into tangible outcomes for residents.
“This is a deliberate and coordinated effort to deepen compliance, strengthen operational alignment, and accelerate the full implementation of the Executive Order on Mandatory Social Health Insurance, particularly at the primary healthcare centres where the impact is most directly felt,” Zamba said.
She recalled that Governor Babajide Sanwo-Olu signed the Executive Order on July 16, 2024, mandating social health insurance for all Lagos residents, a directive further reinforced by a Presidential Executive Order issued on September 12, 2025, which recognised health insurance as a pathway to Universal Health Coverage (UHC).
“As leaders within the primary healthcare system, the responsibility for translating this policy into tangible outcomes rests significantly with you. Primary healthcare centres remain the first point of contact for most Lagos residents and the backbone of the state’s health system,” she added.
Zamba clarified that under the Executive Order, patients presenting at PHCs without proof of enrolment on the ILERA EKO health insurance scheme must not be denied care, stressing that facilities are required to facilitate immediate enrolment.
“Individuals presenting without proof of enrolment must not be turned away. Facilities are expected to facilitate immediate on-the-spot enrolment, ensure enrolment details are properly captured, and guide the patient through activation in line with LASHMA guidelines,” she stated.
She emphasised that emergency cases must be stabilised before any administrative requirements are applied.
“In life-threatening emergencies, patients must be promptly stabilised before any enrolment requirements are applied. Compliance must be embedded into daily workflows, patient management processes and supervisory structures across all primary healthcare centres,” Zamba said.
She disclosed that LASHMA has introduced verification systems and a policy framework for emergency care through the LASHMA-AID (Assistance in Distress) programme launched in December 2025.
Speaking on behalf of district leadership, the Permanent Secretary of Lagos Health District III, Dr. Monsurat Adeleke, urged senior health officials to lead by example and serve as ambassadors of the insurance scheme.
“Out-of-pocket expenditure is the craziest thing that anybody can go through. This is the best opportunity we’ve gotten, especially as the government has made it compulsory for us,” Adeleke said.
She recounted a personal experience involving her driver, who paid out-of-pocket despite being enrolled as a dependent under the scheme.
“My driver is enrolled as a dependent, yet he still paid out-of-pocket at a facility despite having valid coverage. Why must we wait for enforcement before we do it? For us, for our dependents and for patients at our primary centres, let us be ambassadors,” she charged.
Adeleke also called on district heads to ensure widespread dissemination of the policy and engage both public and private stakeholders to drive enrolment.
“The more people get on board, the better and healthier Lagos we are all craving for,” she added.
Earlier, the Coordinator of Regulations at LASHMA, Mr. Tosin Awosika, outlined the legal foundations of the scheme, citing the Lagos State Health Scheme Law No. 4 of 2015, which makes health insurance mandatory for all residents.
“The law established the Lagos State Health Fund as a ring-fenced risk pool and requires residents to subscribe to one of the scheme’s components, including the ILERA EKO plan,” Awosika explained.
He disclosed that the law also created an Equity Fund, representing one per cent of the state’s Consolidated Revenue Fund, to cater for vulnerable populations.
“LASHMA is empowered to register, regulate and sanction HMOs and healthcare providers to ensure compliance and protect residents’ interests,” he said.
The Head of Medical Operations at LASHMA, Dr. Olugbenga Fadipe, reiterated that emergency patients must receive immediate care without upfront deposits.
“The first thing is to treat and stabilise. We do not take deposits before treatment,” Fadipe said, adding that the LASHMA-AID programme guarantees emergency coverage and ambulance services statewide.
He disclosed that PHCs seeking to join the ILERA EKO network must undergo quality assessments using a standardised tool and warned against infractions.
“Facilities must meet quality standards. Charging for covered services, poor infection prevention practices, lack of data reporting and inconsistent pricing will not be tolerated. Numbers don’t lie. Data is important, and compliance is non-negotiable,” he stated.
Participants at the engagement agreed that effective implementation of the Executive Order at the grassroots level is critical to reducing out-of-pocket expenditure, expanding enrolment, improving quality of care and accelerating Lagos State’s progress toward Universal Health Coverage.
