From Nhis to Nhia: A Comparative Evaluation of Preventive Healthcare Utilization Before and after the Health Insurance Reform

Introduction: The transition from the National Health Insurance Scheme (NHIS) to the National Health Insurance Authority (NHIA) marked a major policy shift in the pursuit of Universal Health Coverage (UHC) in Nigeria. While NHIS coverage was limited and skewed toward curative services, the NHIA was introduced in 2022 to expand coverage, mandate enrollment, and integrate preventive healthcare into benefit packages. This study aimed to evaluate changes in preventive healthcare utilization before and after the reform, comparing the performance of NHIS and NHIA models in selected Nigerian states. Methods: A comparative cross-sectional study was conducted across three geopolitical zones using mixed methods. Quantitative data were collected from 403 NHIS/NHIA enrollees using structured questionnaires, while facility records and key informant interviews supplemented the data. Statistical analysis was done using SPSS version 25.0, employing chi-square tests, t-tests, and logistic regression. Qualitative data from 15 interviews were thematically analyzed using NVivo. Results: Preventive service utilization significantly increased under NHIA. Hypertension screenings rose from 41.3% to 65.3%; diabetes screenings from 35.8% to 59.4%; and cervical cancer screenings from 22.6% to 45.1%. Education level, employment status, and awareness of benefits were strong predictors of utilization. Key informants noted improvements in benefit coverage and digital tracking under NHIA, though challenges such as poor rural access, workforce shortages, and funding delays persisted. Discussion: The findings suggest that NHIA has improved preventive healthcare uptake compared to NHIS, reflecting the policy’s enhanced structure and focus. However, persistent structural and systemic barriers may limit long-term impact. To fully realize NHIA’s potential, Nigeria must invest in health infrastructure, workforce capacity, and public health education. The study reinforces that policy reform alone is insufficient without complementary operational and social investments. Conclusion: NHIA has made notable strides in enhancing preventive healthcare utilization compared to the NHIS. Nevertheless, ongoing systemic challenges require targeted investment and stakeholder collaboration to sustain and scale these improvements. Comprehensive reform must go beyond policy frameworks to include equitable implementation, especially for underserved populations.