NHIA pushes health technology reforms to cut waste, expand coverage

Nigeria’s National Health Insurance Authority (NHIA) has positioned itself at the forefront of efforts to institutionalise Health Technology Assessment (HTA), a tool it says is essential for cutting waste, improving efficiency, and expanding access to health care.

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This was discussed during a panel session on “Advancing Health Technology Assessment in Nigeria: A Strategic Imperative for Universal Health Coverage” at the National Health Financing Dialogue in Abuja on Thursday.

Speaking during the session, the Director of Standard and Quality Assurance, NHIA, Yakubu Agada, said the agency is compelled to lead reforms after years of designing benefit packages without the evidence to back them up.

“We’ve had to bring in molecules and devices without actually having the data to justify them. That made it urgent for NHIA to push HTA, because every naira must count,” he said.

He explained that HTA would help Nigeria prioritise scarce resources, strengthen accountability, and align fragmented health financing systems under a transparent, evidence-based process.

HTA is a systematic process that evaluates the medical, economic, social, and ethical implications of health technologies such as medicines, devices, and service delivery models.

Its purpose is to provide evidence and guidance to policymakers and healthcare decision-makers to ensure health systems are safe, patient-focused, and cost-effective.

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Building a national framework for HTA

Mr Agada said the agency is working to establish an inclusive system that involves both federal and state governments, alongside academia and development partners.

“What we want to do is encourage the NHIA to take the step but that we are going to do it together. The states should support NHIA, and the federal government must also be included,” he said.

He stressed that HTA is a necessity, and that Nigeria must begin with a modest system that can grow into a national institution over time.

“Maybe in the future HTA can become an independent agency of government, like the National Institute for Health and Care Excellence (NICE) in the UK. But for now, the most important thing is that Nigeria starts,” he added.

Reforms need legal backing

In his remark, Francis Ukwuije, health economist at the World Health Organisation (WHO), warned that without strong legal and institutional frameworks, Nigeria’s HTA reforms may not last.

Mr Ukwuije explained that HTA must go beyond cost considerations to include safety, clinical effectiveness, equity, ethics, and the unintended consequences of health technologies.

“The mandate of HTA can be very wide. It’s not just about drugs and devices, but also service delivery models and system reforms. Without legal backing, reforms risk collapse when political winds change,” he cautioned.

He also noted that countries with strong HTA systems, such as the UK and Australia, had backed their institutions with law, giving them credibility and continuity.

He added that a properly mandated HTA body would also have the authority to consider not just cost-effectiveness but also broader issues of fairness and impact.

Building local expertise, data systems

Mr Agada acknowledged that one of the barriers to HTA in Nigeria is the lack of high-quality data, but he argued that this should not stall reforms.

“HTA is just a tool for decision making, and decisions must be made whether or not the data is perfect. What matters is building an inclusive system where no one is left behind,” he said.

He noted that Nigerian universities, particularly in Enugu, have begun training experts in health economics while several NHIA staff are currently undergoing specialised training abroad.

Kamil Shoretire, director, Health Planning Research and Statistics, Federal Ministry of Health and Social Welfare, also pledged to push for HTA in medical and public health curricula.

He stressed that embedding HTA into Nigeria’s education system and policy framework is critical for sustainability.

READ ALSO: 90% of Nigerians still lack health insurance coverage- NHIA Boss

“We must embed HTA in the training of tomorrow’s leaders. That way, the system is not dependent on a few experts, but becomes part of how the government runs health,” he said.

He noted that some universities may already touch on HTA at the postgraduate level, but the reform must go further.

“Maybe it’s in the curriculum of some medical schools, but at the Master’s and PhD level, it should start in earnest. Whatever the government wants its own people to know can easily be brought into the curriculum as soon as possible,” he added.

The panellists, however, agreed that HTA has a direct link to health insurance and universal health coverage and by guiding which interventions to fund, HTA can help Nigeria deliver essential services equitably and sustainably.