A Strict Timeline and Expanded Coverage Mechanisms

The Lagos government has announced that all residents, employers, and workers must be covered by health insurance by December 31, 2026, or face penalties starting January 1, 2027. This measure, introduced by the Executive Order EO/BOS/01 of 2024, relies on two complementary schemes: the Lagos Private Health Plans (LPHP), aimed at employees and businesses, and the Ilera Eko program, designed for vulnerable populations and informal workers.

To fund this coverage expansion, the Health Equity Fund has been increased from 1 billion to 3 billion naira, allowing for the inclusion of over 500,000 precarious residents. In 2025, Lagos already had 2.76 million insured individuals, a national record behind Delta State, which covered 1.18 million residents through private organizations (HMOs), according to Nairametrics.

Employers must consider health coverage for their employees as a mandatory expense, on par with pensions or other social obligations.

An Obligation Extended to Employers and Healthcare Facilities

Governor Babajide Sanwo-Olu's decision requires employers to treat health coverage for their employees as a mandatory expense, alongside pensions or other social obligations. This approach aims to systematically integrate health protection into business operational costs, a model that could be adopted in other African economies where health coverage remains fragmented.

Additionally, healthcare facilities are required to stabilize patients needing emergency care before any administrative or financial verification, a measure that strengthens access to critical care and limits refusals of treatment.

What This Changes Here: Implications for Benin and West Africa

The experience of Lagos could serve as a reference for West African countries seeking to universalize health coverage. In Benin, where the public health system faces funding and access challenges, such a reform would require greater mobilization of private actors, such as local mutual funds or insurers, to expand protection. It would also demand stronger coordination between public authorities, employers, and healthcare providers to prevent exclusions.

The creation of a dedicated public fund, such as the Health Equity Fund in Lagos, could inspire similar mechanisms in Benin or Senegal, where informal populations remain largely uncovered. Finally, integrating health insurance into employers' legal obligations would encourage governments to align their legislation with more ambitious regional standards.

A deployment overseen by local and international actors

The implementation of this reform relies on partnerships with 21 private health maintenance organizations (HMOs), which have already adopted the new framework. This public-private collaboration could serve as a model for countries like Ghana or Côte d’Ivoire, where the private sector is increasingly playing a role in healthcare. Additionally, media outlets such as Financial Afrik TV, through programs like The Grand Debate hosted by journalist Dominique Mabika, help raise public awareness and document the challenges of this transition, an approach that could be replicated to support similar reforms across West Africa.