By Bunmi Yekini
The Lagos State Government has intensified enforcement of compulsory health insurance while introducing flexible payment options aimed at bringing more residents, especially low-income earners, into its social health safety net.
At the Y2026 Q1 Media Parley held at the Lagos Chamber of Commerce and Industry (LCCI), the Permanent Secretary of the Lagos State Health Management Agency (LASHMA), Dr. Emmanuella Zamba, said the state is combining policy enforcement with financial innovation to accelerate progress toward Universal Health Coverage (UHC).
“We are not here to deprive people of their rights,” Zamba said during an interview on the sidelines. “We are here to ensure that nobody loses their life needlessly because they cannot access care.”
Her remarks come as Lagos advances the implementation of an Executive Order mandating all residents to enroll in the ILERA EKO social health insurance scheme, a policy now entering a stricter enforcement phase across Ministries, Departments and Agencies (MDAs).
‘No Insurance, No Service’, But With Support
Under the new enforcement model, residents seeking government services, such as school enrolment or licence renewals, will be required to show proof of health insurance coverage. However, she insists the approach is not punitive.
“If you do not have coverage, the system will support you to get enrolled immediately so you are not denied service,” Zamba explained, describing the policy as “moral persuasion backed by structured gatekeeping.”
The first compliance assessment across MDAs has already been completed, with digital verification systems now enabling agencies to check residents’ enrollment status in real time.
The enforcement drive is being coordinated with the Office of the Head of Service, with public servants also facing stricter compliance measures, including integration of insurance status into administrative processes.
Targeting the Informal Sector
Beyond the public workforce, the state is preparing to expand enforcement to the informal sector, arguably the most difficult segment to capture.
Technical Assistant to the Permanent Secretary, Dr. Nifemi Akinnogbe, outlined a phased strategy that will move from MDAs to grassroots communities and eventually to corporate organizations.
This includes partnerships with local governments, community leaders, and regulatory bodies to ensure widespread adoption.
Paying ‘Small Small’ for Big Protection
Recognising economic pressures on households, LASHMA unveiled “ILERA EKO EasyPay,” a wallet-based system that allows residents to contribute gradually toward their insurance premiums.
The initiative builds on the agency’s earlier “Pay-Small-Small” model and is designed to remove the burden of lump-sum payments.
“This is about financial inclusion,” said Rotimi Olatunji, Head of Business Development at LASHMA. “People can save any amount over time, and once the premium is complete, their coverage is activated automatically.”
The scheme is expected to significantly expand access among informal workers and low-income earners who often remain uninsured due to upfront costs.
Bridging Awareness Gaps
Zamba acknowledged that one of the biggest challenges remains public perception.
“Health insurance is still alien to many people,” she said. “People don’t always see the need to pay for healthcare when they are not sick.”
To address this, LASHMA has intensified public education campaigns, including training 72 journalists in partnership with the Institute of Social and Preventive Medicine and Health (ISMPH) to improve reporting on health insurance.
Community engagement has also been scaled up through town hall meetings and collaborations with local government authorities.
Safety Net for the Vulnerable
The state government is also expanding its equity fund to protect vulnerable populations. According to Zamba, Lagos has committed billions of naira to cover residents who cannot afford premiums.
“Even if you have zero naira, you should be able to walk into a facility and receive care,” she said.
Healthcare providers are being trained to ensure that no patient is turned away, even as facilities begin to require proof of enrollment and assist uninsured patients to sign up on the spot.
With enforcement tightening, technology-driven payment options expanding, and grassroots engagement deepening, Lagos is positioning its health insurance scheme as a central pillar of public health.
For the state government, the priority is shifting the burden away from out-of-pocket spending, protecting households from financial shocks, and making healthcare access more predictable and equitable.
“sickness comes without warning, but with insurance in place, families are not left to face the cost alone.” Zambia stated.