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Health insurance is an important mechanism to improve access to healthcare and prevent financial hardship and attain universal health coverage. Although it has been over almost two decades since the launch of the NHIS, only 5% of Nigerians have health insurance and 70% still finance their healthcare through out-of-pocket expenditure. This study, explores the perspectives of sub-national level stakeholders on the design and implementation challenges of Nigeria’s NHIS. The findings identify abject poverty, low level of awareness, low interest (in the scheme), superstitious beliefs, inefficient mode of payment, drug stock-out, weak administrative and supervisory capacity as implementation challenges. NHIS is believed to have provided more coverage for the formal sector. Its voluntary nature and lack of legal framework at the subnational levels are seen as the overarching policy challenge.
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