What is the Role Of Health Maintenance Organizations In Nigeria

Health maintenance organizations play some major roles in the provision of health care and medical services to the Nigerian citizens. Since the Nigerian National health insurance scheme is driven through the Health Maintenance organizations which help to give quality and cost effective health care services to contributors that are under the scheme. Let’s look at the role of Health Maintenance organizations in Nigeria, some of the major roles are as follows:

  • To collect contributions of employer and employees from different parts of the country.
  • To register employer and employees
  • To register service providers, after making sure that they meet the minimum NHIS standards.
  • To give health promotion and education
  • To create an effective quality assurance systems
  • To ensure qualitative and cost effective healthcare services to contributors through the healthcare providers (HCPs).
  • To ensure that contributions that are made are kept in the scheme’s accredited banks.
  • They ensure that processing of claims is done effectively.
  • They also gather appropriate contributions and make necessary payments to the right pools in a timely way.
  • They market in-line with the NHIS guidelines.
  • To ensure that approval of referrals are done within the stipulated time and undertake the necessary follow up to complete the referrals.
  • To market health plans to employers of several public and private sectors.
  • To gather and submit the encounter data forms from healthcare facilities to NHIS.
  • Getting in touch with health care facilities that are only accredited by the scheme with the aim of providing health care services.
  • To follow all the other provisions as outlined in the operational guidelines
  • Conducting functions which are stipulated in the NHIS operational guidelines.
  • To deliver accounts to the National health insurance scheme as required in the operational guidelines.
  • Delivering monthly returns to the scheme on capitation and fee-for service payment to secondary & tertiary healthcare facilities.
  • Providing continuous sensitization and education of the enrollees.
  • To create and ensure that there is a quality assurance system to provide quality healthcare by the health care facilities.
  • Provide risk management enlightenment for enrollers and providers.
  • They should also ensure that disease management guidelines are created so that providers can achieve both high quality and cost effective care.
  • They should have primary and contracted providers in the regions that they cover.

Nigerian health maintenance organization has experienced a slow growth as a result of the poor health care services in the country, But since the country partnered with international bodies, they have been able to market HMOs and also there is commendable penetration in regions that hitherto lacked medical services. Nigeria has to intensify its marketing so that many citizens can be attracted to the health care programmes.

3 Comments. Leave new

Abimbola Josiah Olawumi Idowu
September 1, 2018 5:38 pm

My HMO is Anchor It takes a lot of time via email /phone to get approval for treatment /drug.
It takes the same long time to approve emergencies. I had to make cash payment on one occasion when I was faced with delay and rigorous questions.( IT HAPPENED UNDER RODEINHMO )Finally this HMO does not attend to preventive health matters. For instance I couldn’t get anti oxidant to improve my eye sight .Same goes for WELMAN /Cellgevity to rejuvenate old cells at age, 68years.My request was turned down at Customer Care desk while my email was treated with nonchalance. Is the HMO wanting some body to die. This should not be the purpose of establishing this Institution. PLEASE HELP.


Hello Abimbola, we sympathize with your current experience and hope the situation improves soon. Is your current health insurance cover purchased under individual, family or corporate policy (with your company)? The picture you painted is often the case when an organization decides to go with the cheapest health insurance cover available for their staff (while trying to save cost) or chooses an HMO without the necessary checks on track record.
You may want to take a look again on the class of cover you fall under and the coverage scope therein. If this is however is a policy you purchased individually for yourself or family, then by all means consider switching HMOs ASAP. You are a paying customer and you deserve to be happy with your health insurance policy.


what are the various categories of HMOs. Preferably how does an organization switch HMOs


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