Lagos State’s flagship health insurance initiative, Ilera Eko, launched in 2018 to provide universal health coverage and to shield residents from catastrophic medical costs, is facing serious challenges. Despite its ambitions, many enrollees are reporting that essential services—especially maternal care and emergency procedures—are no longer being covered as promised, forcing patients to pay large sums out of pocket at government hospitals.

Stories from the Frontline

Bosun Aderinoku’s ordeal
Six months after registering under Ilera Eko, Bosun Aderinoku believed his pregnant wife’s care would be covered. But when she required emergency caesarean delivery on October 22, 2025, the hospital asked him to purchase drugs and consumables directly. He estimates he spent over ₦115,000 out of pocket, only to later receive a final bill of ₦294,000. When he sought intervention from the Lagos State Health Management Agency (LASHMA), he was told the maternity package he expected no longer applied to recent enrollees.

Temitope Usman’s surprise bill
Eight months after enrolling, Usman’s wife entered labour requiring surgery. Despite assurances that Ilera Eko would handle delivery costs, staff demanded he supply consumables himself. His claim was later rejected completely by LASHMA, even after a consultant intervened. The surgery succeeded, but Usman is now burdened with hundreds of thousands of naira in medical debt.

These accounts echo a broader pattern documented in a recent PUNCH Healthwise investigation. Enrollees report that procedures once covered—like childbirth and surgery—are now subject to approval delays, scope reductions, or outright rejection.

Policy Shifts and Institutional Confusion

LASHMA and Lagos State have implemented policy changes in mid-2025 that affect benefits previously guaranteed to enrollees. Health workers say new rules require prior approval for some services, while the agency has defended the adjustments as needed for financial sustainability.

The scheme itself has had broad uptake: as of December 2024, over 1.15 million Lagosians were enrolled under Ilera Eko. The state government also enforces a zero-cash premium policy, warning residents against paying premiums into private accounts unrelated to the official health fund.

A spokesperson from LASHMA insisted that notifications about these changes were disseminated via social media and provider channels, though many enrolled patients say they never received any notice. Some providers corroborated the lack of clear communication from the agency prior to implementation.