Efforts to streamline healthcare delivery in Nigeria received a major boost as the National Health Insurance Authority, NHIA, rolled out new service guidelines to address persistent delays in treatment authorisation.

The changes, which took effect from April 1, are aimed at ensuring enrolees of the National Health Insurance Scheme access timely and quality care.

In a statement Mr Emmanuel Ononokpono, Acting Director of Media and Public Relations at NHIA, outlined the fresh measures designed to eliminate long-standing bottlenecks affecting patient care. He said the reforms target efficiency and transparency in healthcare delivery.

A key feature of the new directive is the requirement for Health Maintenance Organisations, HMOs, to issue authorisation codes within one hour of receiving requests from healthcare providers. This step is expected to drastically reduce delays that have frustrated both patients and care providers.

The NHIA stressed that in cases where HMOs are unable to meet the one-hour deadline, they must promptly communicate with both the provider and the enrolee, giving clear and justifiable reasons for the delay. This clause aims to ensure accountability across the healthcare value chain.

Healthcare providers have also been granted the authority to proceed with necessary treatments if authorisation codes are not received within the stipulated timeframe. NHIA will subsequently verify that such services were delivered, thereby preventing treatment interruptions.

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Another provision in the new reforms requires enrolees to report any delays exceeding the one-hour window directly to NHIA. This step empowers patients and strengthens oversight of service providers involved in the healthcare process.

Emergency cases are exempt from prior authorisation, as treatment must commence immediately. However, HMOs are now expected to issue the necessary codes within 48 hours after care has started, ensuring continuity and proper documentation.

To enforce compliance, the NHIA has pledged to impose strict sanctions on any entities that deliberately cause delays in the treatment authorisation process. This is in line with the authority’s mandate to safeguard the health rights of Nigerians.

These reforms, part of the implementation of the NHIA Act 2022, represent a significant stride toward achieving Universal Health Coverage in Nigeria. The NHIA believes that a faster, transparent, and patient-focused approach will help transform public confidence in the health insurance scheme.

Regular reviews will be conducted to assess the impact of the changes, with feedback from stakeholders—healthcare providers, HMOs, and enrolees—playing a critical role in refining the system. The ultimate goal is to build a responsive and efficient healthcare structure that prioritises patient welfare.

NAN