Experts Criticize Eligibility Criteria for Free Caesarean Section Initiative

Maternal health experts have expressed concerns over the eligibility requirements set by the National Health Insurance Authority (NHIA) for accessing free Caesarean Section (CS) services, announced by the Federal Government in November 2024.

The initiative, designed to reduce Nigeria’s high maternal mortality rate, mandates pregnant women to possess a National Identification Number (NIN) and rely on third-party administrators to verify their need for a CS. The Director-General of NHIA, Dr. Kelechi Ohiri, explained that these measures aim to ensure fairness and efficiency.

Ohiri highlighted the importance of accurate identification, emphasizing that the program uses state and national registers alongside NINs for oversight. He added that routine monitoring would safeguard the initiative’s integrity and ensure it benefits the most vulnerable women.

However, experts argue that these criteria could exclude many pregnant women, particularly in rural areas where access to NIN registration remains limited. Current data reveals that only 110 million out of Nigeria’s 223 million population have obtained a NIN.

Consultant gynaecologist Dr. Joseph Akinde criticized the reliance on NINs, stating that rural women are disproportionately affected. He warned that the program is “doomed to fail” without universal NIN coverage. Akinde also noted that requiring third-party administrators could strain hospitals already facing a shortage of medical personnel.

The second Vice President of the Society of Gynaecology and Obstetrics of Nigeria, Professor Christopher Aimakhu, called for the recruitment of more trained professionals to manage the scheme effectively. He expressed concerns that the initiative could unintentionally encourage larger family sizes, potentially exacerbating maternal health risks.

Despite these challenges, NHIA reports that 2,819 women have already benefited during the pilot phase, with over ₦87 million disbursed for life-saving procedures. The program has expanded to 104 facilities nationwide, with several tertiary institutions signing agreements to participate.

Experts are urging the government to review and simplify the eligibility criteria to ensure equitable access and to address systemic barriers that could undermine the program’s success.