One year after Babajide Olusola Sanwo-Olu signed an executive order mandating social health insurance for every resident, the Lagos state government has shifted from policy declaration to enforcement, moving to integrate its estimated 20 million population into structured health coverage.
This is even as the Lagos State Health Management Agency (LASHMA) convened permanent secretaries from the six health districts, directors of medical services and medical officers of health across the 57 LGAs and LCDAs, in Lagos, signalling that compliance at the grassroots can no longer be optional.
The July 16, 2024 Executive Order made enrolment compulsory. But officials admit that ensuring full adherence, particularly at the Primary Healthcare Centre (PHC) level, is the real test. PHCs remain the first point of contact for most residents and serve as the backbone of community-based healthcare delivery in Africa’s most populous state.
Emmanuella Zamba, permanent secretary of LASHMA, described the latest engagement as a deliberate escalation in implementation.
“This is a deliberate and coordinated effort to deepen compliance, strengthen operational alignment and accelerate full implementation of the Executive Order,” she said, stressing that district leaders must now translate policy into measurable outcomes.
Read also: Lagos moves to reduce out-of-pocket costs with expanded Ilera-Eko scheme
Under the enforcement framework, residents who present at PHCs without proof of enrolment under the ILERA EKO scheme are not to be denied care. Instead, facilities are required to carry out provider-led, on-the-spot enrolment, capture patient data correctly and activate coverage immediately in line with LASHMA guidelines.
For emergency cases, treatment takes precedence over paperwork.
Zamba emphasised that life-threatening situations must be stabilised before any insurance processes are triggered, noting that the LASHMA-AID (Assistance in Distress) programme, launched in December 2025, was designed to guarantee emergency response coverage, including ambulance services statewide.
The enforcement push also draws legal authority from the Lagos State Health Scheme Law No. 4 of 2015, which established health insurance as mandatory and created the Lagos State Health Fund (LASHEF) as a ring-fenced risk pool. The law further provides for an Equity Fund funded by one per cent of the state’s Consolidated Revenue Fund to cover vulnerable residents who cannot afford premiums.
Tosin Awosika, coordinator of regulations at LASHMA, reminded health administrators that the agency is empowered to register, regulate and sanction HMOs and healthcare providers to protect enrollees and enforce standards.
Operational compliance, however, remains central.Olugbenga Fadipe, head of medical operations at LASHMA, warned PHCs against infractions such as charging for services already covered under the scheme, demanding deposits before stabilising patients, poor infection control practices and weak data reporting.
“First thing is to treat and stabilise. We do not take deposits before treatment. Numbers don’t lie. Data is important, and compliance is non-negotiable,” Fadipe said.
Speaking for the district leadership, Monsurat Adeleke, permanent secretary of Lagos Health District III, acknowledged that enforcement must begin with those within the system.
“Out-of-pocket expenditure is the craziest thing that anybody can go through. This is the best opportunity we’ve gotten, especially as government has made it compulsory for us,” she said, urging health officials to lead by example.
Read also: Lagos launches LASHMA-AID, guarantees emergency care before payment
She recounted a case where her driver, enrolled as a dependent, still paid out-of-pocket at a facility despite valid coverage, an illustration of the implementation gaps the state now seeks to close.
“Why must we wait for enforcement before we do it? For us, for our dependents and for patients at our primary centres, let us be ambassadors,” she added.
Health economists have long warned that high out-of-pocket spending pushes families into poverty and weakens preventive care uptake. Lagos officials argue that locking in its 20 million residents under a structured insurance pool will expand financial protection, stabilise provider payments and move the state closer to Universal Health Coverage.
With one year gone since the Executive Order was signed and a subsequent Presidential Executive Order in September 2025 reinforcing health insurance as a national priority, Lagos appears determined to ensure that compulsory coverage is no longer aspirational policy but everyday practice at the community level.
For Africa’s commercial nerve centre, the next phase is clear: convert legal mandate into universal participation and turn primary healthcare centres into the gateway for financial protection in health.
