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Lagos – The Lagos State Government has intensified moves to enforce its Executive Order on Mandatory Social Health Insurance, convening a high-level strategic engagement with Permanent Secretaries of the six Health Districts, Directors of Medical Services (DMS), and Medical Officers of Health (MOHs) across Local Government Areas (LGAs) and Local Council Development Areas (LCDAs) to accelerate implementation at the primary healthcare level.
At the meeting held in Ikeja, the Permanent Secretary of the Lagos State Health Management Agency (LASHMA), Dr. Emmanuella Zamba, described the engagement as a “deliberate and coordinated effort to deepen compliance, strengthen operational alignment, and accelerate the full implementation of the Executive Order on Mandatory Social Health Insurance,” particularly at the Primary Healthcare Centres (PHCs) where impact is most directly felt.
Zamba reminded participants that Governor Babajide Olusola Sanwo-Olu signed the Executive Order on July 16, 2024, mandating social health insurance for all residents, a directive further reinforced by the Presidential Executive Order of September 12, 2025, affirming health insurance as a pathway to Universal Health Coverage (UHC). She noted that LASHMA had since embarked on structured engagements beginning with the Body of Permanent Secretaries and Heads of Agencies before cascading discussions to district and PHC leadership
“As leaders within the Primary Healthcare system, the responsibility for translating this policy into tangible outcomes rests significantly with you,” Zamba said, stressing that PHCs remain the first point of contact for most Lagos residents and the backbone of the state’s health system.
She clarified that under the Executive Order, individuals presenting at PHCs without proof of enrolment on the ILERA EKO Scheme must not be turned away. “Facilities are expected to facilitate immediate on-the-spot enrolment through the provider-led enrolment process, ensure that enrolment details are properly captured, and guide the patient through activation in line with LASHMA guidelines,” she stated.
According to her, in life-threatening emergencies, patients must be promptly stabilised before any enrolment requirements are applied, assuring that LASHMA has introduced verification systems, provider-led enrolment processes and a policy framework for emergency care through the LASHMA-AID programme launched in December 2025. “Compliance must be embedded into daily workflows, patient management processes, and supervisory structures across all PHCs,” she emphasised.
Speaking on behalf of other district Permanent Secretaries, the Permanent Secretary of Lagos Health District III, Dr. Monsurat Adeleke urged health leaders to become ambassadors of the scheme, revealing that even some senior officials had yet to fully activate their coverage. “Out-of-pocket expenditure is the craziest thing that anybody can go through. This is the best opportunity we’ve gotten, especially as the government has made it compulsory for us,” she said.
Adeleke recounted a personal experience where her driver, enrolled as a dependent, still paid out-of-pocket at a facility despite having valid coverage. “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 charged.
She further called on district heads to ensure “the widest circulation” of the policy within their jurisdictions and to engage both the public and private sectors in driving enrolment. “The more people get on board, the better and healthier the Lagos we are all craving for,” she added.
Earlier, the coordinator, Regulations at LASHMA, Mr. Tosin Awosika highlighted the legal foundations of the scheme, noting that the Lagos State Health Scheme (LSHS) Law No. 4 of 2015 makes health insurance mandatory for all residents and established the Lagos State Health Fund (LASHEF) as a ring-fenced risk pool. He explained that residents are required to subscribe to any of the three components of the scheme, including the ILERA EKO plan.
Awosika added that the law created an Equity Fund, representing one per cent of the state’s Consolidated Revenue Fund, to cater for vulnerable populations, while LASHMA is empowered to register, regulate and sanction HMOs and healthcare providers to ensure compliance and protect residents’ interests.
On operationalisation at the PHC level, Head of Medical Operations at LASHMA, Dr. Olugbenga Fadipe said facilities must stabilise emergency cases without demanding deposits upfront. “First thing is to treat and stabilise. We do not take deposits before treatment,” he said, explaining that the LASHMA-AID (Assistance in Distress) programme guarantees emergency coverage and ambulance services statewide.
Fadipe disclosed that PHCs seeking to join the ILERA EKO network must undergo quality assessments using a standardised tool. He warned against infractions such as charging for covered services, poor infection prevention practices, lack of data reporting, and inconsistent pricing. “Numbers don’t lie. Data is important, and compliance is non-negotiable,” he stated.
Participants at the engagement agreed that effective implementation of the Executive Order at the grassroots remains critical to reducing out-of-pocket expenditure, expanding enrolment, improving quality of care, and fast-tracking Lagos State’s march toward Universal Health Coverage.
