HEALTHCARE AS ECONOMIC INFRASTRUCTURE

Kelechi Ohiri, director-general of NHIA, is one of the country’s foremost health reformers, writes BASHIR IBRAHIM HASSAN

Economic reforms dominate Nigeria’s public discourse. Inflation, taxation, exchange rates and fiscal deficits command headlines almost daily. Yet beneath these familiar debates lies a quieter question with far greater implications for the country’s long-term prosperity: who will build the Nigeria those reforms are meant to serve?

For Kelechi Ohiri, director-general of the National Health Insurance Authority (NHIA), the answer begins with people. “We don’t make enough reference to Nigeria’s greatest resource, which is human capital,” he observed during a fireside conversation at the BusinessDay CEO Forum. It was a simple statement, delivered without rhetorical flourish, yet it captured a philosophy that has defined his career across medicine, global development and public policy.

Unlike many healthcare leaders who see hospitals, insurance schemes and disease control as ends in themselves, Ohiri views healthcare as economic infrastructure. Healthy populations are more productive. Productive citizens build stronger businesses. Stronger businesses create wealth. Universal health coverage, in his worldview, is not merely a social obligation. It is a national competitiveness strategy.

That conviction explains why one of Africa’s most accomplished health policy professionals returned home in 2023 to lead an institution long regarded as one of Nigeria’s most difficult public sector assignments. At first glance, the move seemed counterintuitive.

Before his appointment by President Bola Ahmed Tinubu as director-general of the NHIA, Ohiri had assembled the kind of international career many public policy professionals spend a lifetime pursuing. A medical doctor trained at the University of Lagos, he later earned both a Master of Public Health and a Master of Science in Health Policy and Management from Harvard University before joining McKinsey & Company’s London office, where he advised governments and institutions across Europe, the Middle East and Africa. He subsequently joined the World Bank through its prestigious Young Professionals Programme, working on health financing and social protection reforms before moving to Gavi, the Vaccine Alliance, where he rose to become chief strategy, policy and innovation officer.

Few professionals accumulate experience across clinical medicine, strategy consulting, multilateral finance and global health institutions with such ease. Fewer still choose to exchange those platforms for the demanding realities of public sector reform at home. Yet the decision was entirely consistent with Ohiri’s philosophy. Throughout his career, he has gravitated towards systems rather than programmes.

As special adviser to successive Nigerian ministers of health and later to the minister of finance, he helped shape reforms that extended beyond healthcare, including the Saving One Million Lives Programme and the conceptual foundations of Nigeria’s National Social Safety Nets Programme. These initiatives reflected his enduring belief that poverty, health and economic opportunity cannot be addressed in isolation. That systems perspective would become even more pronounced at Gavi.

There, he contributed to the strategic direction of one of the world’s most successful public health partnerships, helping guide policies that have enabled the immunisation of more than one billion children across lower-income countries while strengthening national health systems. The experience reinforced an important lesson: sustainable progress depends less on isolated interventions than on institutions capable of scaling impact over decades.

It is precisely that lesson he brought to the NHIA. For years, Nigeria’s health insurance system struggled with low enrolment, fragmented financing and widespread public scepticism. Healthcare remained overwhelmingly financed through out-of-pocket spending, leaving millions of households vulnerable to financial hardship whenever serious illness struck.

Ohiri inherited more than an agency. He inherited one of Nigeria’s most significant structural development challenges. His response has been to redefine the institution’s purpose.

The NHIA, under his leadership, is no longer presented simply as an insurance administrator. It is increasingly positioned as the financial architecture underpinning universal health coverage and, by extension, one of the foundations of long-term economic resilience. That ambition is already reflected in measurable progress.

Through closer collaboration with state governments, accelerated implementation of the National Health Insurance Act and targeted interventions for vulnerable populations, health insurance coverage has expanded steadily under his leadership, rising from approximately 16 million beneficiaries when he assumed office to more than 22 million Nigerians. At the same time, the Authority has introduced reforms in strategic purchasing, digital systems and quality assurance designed to improve both efficiency and public confidence.

Yet statistics, while important, reveal only part of the story. Universal health coverage is not an aspiration measured by insurance cards issued or hospitals accredited. It is measured by whether a mother survives childbirth, whether a worker remains productive, whether a child stays in school because illness did not bankrupt the family, and whether businesses spend less replacing exhausted talent and more creating value.

It is a philosophy that increasingly distinguishes his leadership from traditional health administration. At the BusinessDay CEO Forum, he urged chief executives to abandon the narrow view of healthcare as an employee benefit or welfare programme.

“Every CEO understands that people are the organisation’s greatest asset,” he said. “The question is not simply how we pay for treatment when employees become sick. It is how we help them remain healthy throughout their productive lives.”

That shift – from treating illness to producing health – has become the organising principle of the NHIA’s reform agenda. Under Ohiri’s leadership, the Authority has expanded beyond financing curative care to promoting prevention, wellness and financial protection. Programmes now place greater emphasis on maternal health, vulnerable populations, quality improvement and strategic purchasing, ensuring public resources reward better outcomes rather than merely higher volumes of care.

Among the most visible reforms is the Comprehensive Emergency Obstetric and Maternal Care initiative, which finances life-saving emergency services for pregnant women across hundreds of health facilities. In a country that accounts for one of the world’s highest maternal mortality burdens, the programme demonstrates how targeted health financing can directly improve survival while protecting families from catastrophic medical costs. 

Technology forms another pillar of his strategy. Artificial intelligence, telemedicine, electronic medical records and digital identity systems feature prominently in his vision, not because they represent fashionable innovation, but because they offer practical solutions to structural constraints.

Nigeria, he argues, cannot wait decades to build enough hospitals, train enough specialists or deploy enough healthcare workers through conventional models alone. Digital technology offers the opportunity to leapfrog those limitations.

Innovation without scale, he argued, changes little. Nigeria has produced no shortage of successful pilot projects. Its challenge has been converting those pilots into national systems.

During the CEO Forum, he pointed to countries that deliberately invested in health and education before experiencing decades of sustained economic expansion. Nigeria, with one of the world’s youngest populations, faces a similar opportunity. Its demographic dividend, however, is not guaranteed.

Without sustained investment in human capital, today’s youthful population risks becoming tomorrow’s development burden. With the right investments, it could become Nigeria’s greatest economic advantage. That argument resonates well beyond government.

Increasingly, business leaders recognise that workforce productivity depends not only on technology or organisational design, but also on physical health, mental wellbeing and financial resilience. Poor health raises operating costs, reduces output, weakens competitiveness and undermines economic growth. For Ohiri, the distinction between health policy and economic policy is therefore largely artificial. Asked what single decision Nigeria must make over the next five years to secure its future, he resisted offering a silver bullet. Instead, he returned to first principles. “We cannot wait for prosperity to trickle down,” he said. “Government, businesses and institutions must deliberately invest in human capital while ensuring those investments reach every segment of society.”

He is betting that nations become prosperous not because they first become wealthy, but because they first invest in the health, capability and dignity of their people. If that proposition continues to shape Nigeria’s health financing reforms, his tenure at the NHIA may ultimately be remembered for something larger than expanding insurance coverage.

It may be remembered as the moment healthcare ceased to be viewed as social expenditure and began to be recognised for what it has always been: one of the country’s most valuable economic assets.

Hassan writes from Abuja