Before the 2022 National Health Insurance Authority Act, which made health insurance mandatory for all citizens and legal residents, nationwide registration on a health insurance scheme was only 3%. Most of the subscribers work in the formal sector. However, only 19 in 100 Nigerians had health insurance in 2024.
**Are there any countries with similar initiatives?**
Some African countries have taken steps to improve access to life-saving maternal healthcare interventions, including caesarean section, by removing user fees.
Examples are Benin, Burkina Faso, Ghana, Kenya, Mali, Morocco, Niger and Senegal.
Though evidence on the affect of free caesarean section policies on reducing maternal mortality is not conclusive, there are now higher rates of caesarean section, particularly among women from lower-income, rural and less educated backgrounds.
Free delivery and caesarean section policies in Ghana and Burkina Faso led to a 45% reduction in the neonatal mortality rate and 54% reduction in infant mortality rate compared to Nigeria and Zambia where no such policies existed. This suggests that the benefits of such schemes go beyond pregnancy and childbirth.
**What needs to happen to ensure the policy succeeds?**
There are lessons from countries that have implemented similar schemes.
“Free” caesarean without free delivery may lead to more women being identified as needing a caesarean, since the vaginal childbirth might come at a higher cost to the pregnant woman. While a caesarean can be life-saving, unnecessary surgeries are not advised, as it is not risk-free. Making both vaginal childbirth and caesarean “free” should be considered.
Free needs to truly mean free. Stockout of medications, blood and blood products, and consumables might force people to pay to get them.
Skilled health personnel must follow clear guidelines to assess whether a caesarean is necessary or not. Audit and feedback on the use of the procedure will help in identifying any patterns of abuse or misuse.