ASHIA Drops Compulsory NIN for Vulnerable Patients

By Praise Chinecherem

The Anambra State Health Insurance Agency (ASHIA) has initiated steps to review the compulsory use of the National Identification Number (NIN) for enrollment into the state health insurance scheme following concerns raised by the AIDS, Tuberculosis and Malaria (ATM) Network in Anambra State.

The ATM Network — comprising the TB Network, the Network of People Living with HIV/AIDS in Nigeria (NEPWHAN), and the Association for the Control of Malaria in Nigeria (ACOMIN) — raised the concerns during an advocacy visit to the Executive Director/Chief Executive Officer of ASHIA, Dr. Ezeka Augustine Uwaeme.

The meeting focused on strengthening enrollment of tuberculosis (TB) patients into the ongoing Global Fund-supported health insurance pilot scheme and improving Primary Health Care (PHC) outcomes through collaboration and evidence generated from the Integrated Community-Led Monitoring (CLM) project supported by the Institute of Human Virology Nigeria (IHVN).

Leading the delegation, the State Coordinator of the TB Network, Ify Unachukwu, highlighted several challenges affecting the enrollment of TB patients into the health insurance scheme, identifying the compulsory NIN requirement as a major obstacle for many vulnerable residents.

According to her, many TB patients either delayed or abandoned enrollment because they could not afford the cost of obtaining a NIN or were unable to provide it during registration.

Unachukwu explained that the two-year health insurance pilot project was designed to provide comprehensive health insurance coverage for TB patients and their dependants across Anambra State.

Presenting progress reports, the team disclosed that as of the third quarter of 2025, a total of 382 Drug-Susceptible TB patients and 63 Drug-Resistant TB patients had been enrolled into the scheme, although the figures remained below the project’s cumulative targets.

The ATM Network also identified low awareness of health insurance benefits, missed enrollment opportunities, and poor integration of community feedback into healthcare improvement processes as additional implementation challenges.

To address the gaps, the group urged ASHIA to strengthen collaboration with community structures to improve enrollment outcomes, data sharing, and PHC service delivery.

Among the recommendations presented were the engagement of TB Network Linkage Coordinators to support enrollment at DOT clinics and PHCs, quarterly joint planning sessions using CLM data, and intensified awareness campaigns to encourage TB patients and their dependants to enroll in the scheme.

Responding, the Executive Director of ASHIA, Dr. Ezeka Augustine Uwaeme, described the compulsory NIN requirement as a major encumbrance to healthcare access, especially for poor and vulnerable citizens.

He questioned the rationale behind making access to healthcare dependent on a process many struggling residents could not afford.

According to him, health insurance schemes perform better when more people are enrolled.

Dr. Ezeka further observed that several residents had abandoned enrollment because they could not obtain or present a NIN.

Consequently, he directed the ASHIA Information Technology Unit to stop making NIN a compulsory field for enrollment into the Anambra State Health Insurance Scheme.

He noted that alternative legal means of identification exist and should be explored to avoid placing additional financial burdens on vulnerable populations.

The ASHIA boss also pledged to engage relevant national authorities on the issue and advocate reforms that would support inclusive enrollment for TB patients and other vulnerable groups.

The meeting ended with a resolution to strengthen collaboration between ASHIA and the ATM Network to improve TB enrollment, expand community awareness, and integrate CLM findings into PHC quality improvement efforts across the state.

The ATM Network pledged continued support to ASHIA through evidence-based advocacy, community mobilization, and monitoring mechanisms aimed at ensuring wider healthcare access and improved PHC outcomes in Anambra State.

Other members of the advocacy team included Gladys Ezembu of NEPWHAN, Chioma Okeke of ACOMIN, and Onyekachi Ololo, State Programme Officer of the TB Network.