Lessons From Ghana: A Cross-National Comparative Study of Social Health Insurance Frameworks in Nigeria and Ghana

Abstract This cross-national comparative study investigates the social health insurance frameworks of Nigeria and Ghana between 1999 and 2024. Employing structural functionalism as a theoretical framework, the study examines critical areas including stakeholder engagement, governance structures, regulatory oversight, funding mechanisms, and public awareness initiatives. Ghana's National Health Insurance Scheme (NHIS) has demonstrated relative success through effective stakeholder engagement, transparent governance, extensive public education campaigns, and diversified financing, leading to higher enrolment rates, improved financial sustainability, and increased public trust. Conversely, Nigeria’s NHIS has faced persistent challenges such as low enrolment, limited stakeholder involvement, inadequate regulatory oversight, financial instability, and poor public perception, significantly constraining its effectiveness and sustainability. The comparative analysis highlights key factors contributing to Ghana’s success, providing valuable insights and actionable strategies for Nigeria. The study advocates for enhancing stakeholder participation, strengthening regulatory frameworks, improving transparency and accountability, implementing comprehensive public education strategies, and diversifying funding sources. These recommendations, supported by practical implementation strategies including capacity building, robust digital infrastructure, phased policy rollouts, and rigorous monitoring, present a strategic pathway to transform Nigeria’s NHIS. Adopting these lessons from Ghana, tailored to Nigeria’s specific context, could substantially improve healthcare accessibility, equity, and ultimately achieve sustainable universal health coverage, significantly enhancing the health and well-being of the Nigerian populace.