The Lagos State Government has intensified enforcement of its Executive Order on Mandatory Social Health Insurance, urging Local Government and Local Council Development Area (LCDA) chairmen to spearhead grassroots implementation in a renewed drive toward universal health coverage.
This formed the focus of a strategic one-day retreat with LGA/LCDA chairmen under the aegis of Conference 57 on implementing the Executive Order. The event, held at Lagos Continental Hotel, brought together top government officials to rally the third tier of government to deepen enrolment in the Lagos State Social Health Insurance Scheme, popularly known as ILERA EKO.
Speaking at the retreat, Chairman of the House Committee on Health, Hon. Lawal Aina Musibau, said the Lagos State House of Assembly had laid the legal foundation for sustainable healthcare financing through the Lagos State Health Scheme Law of 2015, which established the Lagos State Health Management Agency (LASHMA) and the Lagos State Health Fund.
He reminded chairmen that enforcement of the mandatory health insurance policy had commenced, stressing that “awareness alone is insufficient; deliberate action and sustained commitment are required to guarantee compliance and affordable healthcare for our people.”
Musibau urged Conference 57 to take full ownership of the scheme, sponsor vulnerable residents where feasible, and collaborate closely with LASHMA to address operational challenges. He declared the retreat open “to the glory of God” and reaffirmed legislative backing for the reform.
In his remarks, the Head of Service, Mr. Bode Agoro, described the Executive Order signed on July 16, 2024, as “a bold reform aimed at guaranteeing universal health coverage for all residents of Lagos State.”
Agoro disclosed that his office had issued compliance circulars, convened strategy sessions with permanent secretaries and agency heads, and inaugurated a 26-member enforcement team to drive institutional adherence. He added that proof of enrolment is now required to access certain government services.
“Compliance is not optional; it is a statutory obligation,” he said, noting that enforcement had begun in some ministries, departments and agencies (MDAs), with full compliance expected by the second quarter. He urged council chairmen to mobilise political office holders, staff and residents within their jurisdictions.
Delivering the keynote address, the Commissioner for Health, Prof. Akin Abayomi, contextualised the reform within health economics, highlighting the balance between supply and demand in healthcare delivery.
On the supply side, he cited ongoing investments in infrastructure, equipment and human resources, including the establishment of a standalone University of Medicine and Health Sciences to boost the training of doctors, nurses and allied professionals.
On healthcare financing, Abayomi noted that a significant proportion of medical expenses in Nigeria are paid out-of-pocket, a model he described as unsustainable and inequitable. He said mandatory insurance would replace informal, connection-based assistance with a structured, equitable and sustainable system.
He added that laws without enforcement mechanisms often remain ineffective, stating that the Executive Order strengthens the legal framework and underscores government’s resolve to ensure that every resident has a health insurance plan, whether self-funded or subsidised for vulnerable groups.
Earlier, the Board Chairman of LASHMA, Dr. Adebayo Adedewe, described the retreat as marking a renewed phase of grassroots-driven implementation of ILERA EKO.
Adedewe commended Governor Babajide Sanwo-Olu for his leadership and reminded chairmen that LGAs and LCDAs, being the closest tier of government to the people, play a critical role in achieving universal enrolment.
“Experience has shown that when local governments take ownership, enrolment increases; and when leadership speaks clearly, communities listen,” he said, urging integration of ILERA EKO advocacy into town hall meetings, ward engagements and other community platforms.
Also speaking, the Permanent Secretary of LASHMA, Dr. Emmanuella Zamba, outlined key areas of collaboration, including the designation of two enforcement officers per council to work with the state team.
She emphasised that enforcement is compliance-driven rather than punitive, noting that weekly review meetings, local permit structures and market associations would serve as strategic touchpoints for expanding coverage.
Zamba also requested office space within council premises, support for stakeholder mobilisation, advocacy videos by chairmen, onboarding of additional Primary Health Centres for 24-hour services, and backing for door-to-door campaigns supported by the Clinton Health Access Initiative and the National Health Insurance Authority.
In her goodwill message, the Permanent Secretary, Ministry of Local Government, Chieftaincy and Rural Development, Mrs. Kikelomo Bolarinwa, said full implementation of the scheme would significantly reduce the financial burden on councils frequently approached by indigent residents for hospital bill support.
She urged maximum cooperation with LASHMA officials and encouraged chairmen to internalise lessons from the retreat, describing the programme as vital to inclusive and sustainable healthcare financing.
Similarly, the Permanent Secretary, Office of the Auditor-General for Local Government, Mr. Obafemi Ogunlana, said access to quality healthcare is a core dividend of democracy that must transcend political affiliations.
He encouraged council leaders to incorporate ILERA EKO advocacy into routine engagements with constituents, stressing that increased enrolment would improve health outcomes, strengthen community trust and promote inclusive governance.
The highlight of the retreat was the decoration of all 57 chairmen as ILERA EKO Champions, symbolising their commitment to intensifying enrolment and enforcement efforts across their jurisdictions.
Ten chairmen were further honoured as EKOSHA Icons for committing resources, office space and strategic support to enrol vulnerable and indigent residents under the equity fund framework.
With enforcement already underway in MDAs and expansion to the informal sector imminent, stakeholders expressed confidence that strengthened state–local collaboration would accelerate Lagos State’s progress toward universal health coverage and protect residents from catastrophic health expenditures.
