Nigeria Moves to Institutionalise Health Technology Assessment as NHIA Targets More Evidence-Based Healthcare Spending

By Simpson Global Media News Desk

ABUJA — Nigeria has taken a new step towards making evidence-based assessment a formal part of decisions about healthcare coverage, purchasing, reimbursement and the allocation of limited health resources, with the Federal Government inaugurating a National Health Technology Assessment Steering Committee.

The initiative, being led through the National Health Insurance Authority (NHIA), is designed to establish Health Technology Assessment (HTA) as a structured process for examining the clinical, economic, social, organisational and ethical implications of medicines, medical devices, diagnostics, procedures and other health interventions before major coverage and financing decisions are made.

The development comes as Nigeria continues to pursue Universal Health Coverage (UHC) while facing competing demands for limited healthcare resources. The NHIA says its HTA programme is intended to strengthen strategic purchasing and ensure that decisions about what health services are covered, how they are purchased and what purchasers pay are informed by evidence rather than made without a systematic assessment of value and impact.

The steering committee's inauguration represents the latest stage of a process that the NHIA says has been under development for more than two years. The Authority established a dedicated Health Technology Assessment Division within its Strategic Purchasing Department in 2025 and has since developed a national framework, operational guidance and other tools intended to support the assessment process.

The new framework could eventually influence how Nigeria evaluates expensive treatments, medical technologies, screening programmes and other interventions as the country's health insurance system expands.

What Health Technology Assessment Means

Health Technology Assessment is a multidisciplinary approach used to examine the value and consequences of health interventions.

The term "technology" in HTA does not refer only to digital devices or advanced machines.

It can include medicines, vaccines, diagnostic tests, medical equipment, surgical procedures, screening programmes, healthcare delivery models and other interventions designed to prevent, diagnose, treat or manage disease.

An assessment can examine several dimensions at once.

These may include whether an intervention works clinically, how much it costs, how it compares with alternatives, its effect on patients and health systems, its implications for equity, and ethical or organisational considerations.

The NHIA describes HTA as a structured, evidence-based process for evaluating the clinical effectiveness, cost, equity, ethical and health-system implications of healthcare interventions and technologies before coverage and pricing decisions are made.

That approach is particularly relevant to health insurance because an insurance purchaser cannot necessarily cover every available medicine, procedure or technology for every patient.

The question becomes how limited resources should be allocated across competing healthcare needs.

HTA is intended to provide evidence that can help decision-makers examine those choices systematically.

The objective is not simply to identify the newest or most technologically advanced intervention.

Instead, the assessment considers whether an intervention produces sufficient health benefit relative to its cost and other consequences, while also taking account of equity and the realities of the health system in which it will be used.

Steering Committee Begins National Framework

The Federal Government's new National HTA Steering Committee has been given a strategic role in establishing the system.

According to the NHIA, its responsibilities include providing strategic oversight and guidance for the national HTA system, supporting transparent prioritisation of assessment topics, strengthening methodological standards and safeguards against conflicts of interest, encouraging stakeholder and citizen engagement, developing local capacity and creating pathways through which HTA findings can inform health policy, benefit-package design, strategic purchasing and reimbursement.

The committee includes representatives from government, state health authorities, academia, regulatory institutions, public-interest organisations and the NHIA's HTA Secretariat.

Among those listed by the NHIA are NHIA Director-General and Chief Executive Officer Dr Kelechi Ohiri; Dr Ovuoraye John of the Federal Ministry of Health and Social Welfare; Dr Banji Filani, chairman of the Forum of State Commissioners for Health; Dr Muhammed Safana, chairman of the Forum of CEOs of State Social Health Insurance Agencies; health economist and academic Prof Obinna Onwujekwe; NAFDAC Director-General Prof Moji Adeyeye; Prof Bala Audu representing public interest; and Nigeria Health Watch Managing Director Vivianne Ihekweazu.

The structure is intended to bring different perspectives into the assessment process.

That is important because decisions about healthcare spending do not involve clinical evidence alone.

A treatment may be clinically effective but difficult to deliver in parts of Nigeria.

A diagnostic technology may produce valuable results but require electricity, specialist personnel or maintenance systems that are unavailable in some facilities.

A medicine may be effective but significantly more expensive than another treatment producing similar outcomes.

A screening programme may provide substantial benefits over time while requiring upfront investment.

HTA provides a framework for considering these factors together.

Why the Reform Matters for Health Insurance

Health insurance systems are built around a fundamental financing challenge: available funds are limited while healthcare needs are potentially unlimited.

Nigeria's NHIA is working to expand financial access to healthcare through formal-sector, informal-sector, vulnerable-group and other programmes.

The Authority's public information states that its mandate covers Nigerians and legal residents and includes programmes for formal-sector workers, the organised private sector, informal-sector participants, vulnerable groups and other categories.

As insurance coverage expands, the range of demands placed on purchasers can also increase.

Patients and healthcare providers may seek access to newer medicines, advanced diagnostic equipment, cancer treatments, dialysis, surgical procedures and other specialised interventions.

At the same time, health authorities must finance routine primary healthcare, maternal and newborn services, infectious disease control, chronic disease management, medicines and other essential services.

HTA is intended to provide a systematic way of examining those competing demands.

The NHIA says institutionalising HTA should strengthen decisions on healthcare coverage, reimbursement, pricing and resource allocation as Nigeria works towards Universal Health Coverage.

This places HTA within the broader concept of strategic purchasing.

Strategic purchasing involves deliberate decisions about which healthcare services to buy, for whom, from which providers, at what price and on what evidence.

Instead of simply paying for whatever services are presented, a strategic purchaser uses information about health needs, costs, quality and outcomes to guide purchasing decisions.

From Policy Concept to Institutional Programme

Nigeria's HTA initiative did not begin with the inauguration of the new committee.

The NHIA says it established a Strategic Purchasing Department with a dedicated HTA Division in 2025.

Since then, it has developed several tools, including an HTA Framework, Reference Case, Process Guidelines, Terms of Reference, a conflict-of-interest policy and stakeholder mapping and analysis.

These tools are intended to provide consistency.

Without common procedures, different assessments could use different assumptions, methods or standards, making it difficult for decision-makers to compare findings.

A national framework can establish expectations around the questions to be asked, the evidence to be considered, the way costs and outcomes are measured and how stakeholders participate.

The NHIA has also established procedures intended to address conflicts of interest.

That issue is particularly important in health technology assessment because pharmaceutical companies, medical-device manufacturers, healthcare providers, insurers, researchers and government agencies can have different interests in the outcome of a decision.

The NHIA says its national framework includes safeguards around conflicts of interest as part of the effort to strengthen the credibility of the process.

Three Pilot Assessments

Before the national institutionalisation process, the NHIA tested its emerging approach through three pilot assessments.

The pilots covered kidney replacement therapy, colorectal cancer screening and sorafenib for advanced liver cancer.

The choice of subjects provides an indication of the kinds of questions HTA could eventually address in Nigeria.

Kidney replacement therapy involves complex decisions about treatments such as dialysis and kidney transplantation.

Such services can require substantial financial, human-resource and infrastructure commitments.

An HTA assessment can examine the costs and health outcomes associated with available approaches and help decision-makers understand the implications of different strategies.

The colorectal cancer screening assessment addresses a different type of question.

Screening programmes are designed to identify disease or precancerous conditions before symptoms become apparent.

Their value can depend on factors including the population targeted, screening method, participation rates, follow-up capacity, treatment availability and the long-term health effects of early detection.

The third pilot involved sorafenib, a medicine used in the management of advanced liver cancer.

A medicine assessment can examine clinical effectiveness, safety, costs and alternative treatment options, among other considerations.

Together, the three pilots allowed the NHIA to test its assessment methods across different types of health interventions.

Building Nigerian Evidence

A central issue in health technology assessment is the quality and relevance of the evidence used.

Evidence generated in another country can be useful, but healthcare systems differ.

Medicine prices vary.

Disease patterns vary.

Healthcare infrastructure varies.

Patient preferences and treatment pathways vary.

Income levels and access to services vary.

For that reason, Nigeria's HTA programme is also developing local evidence.

The NHIA says it has supported Nigerian postgraduate researchers at Mahidol University in Thailand as part of its effort to develop specialised HTA capacity.

The Authority has also supported a Nigerian EQ-5D-5L valuation study.

EQ-5D-5L is a standardised instrument used in health economics to measure health-related quality of life.

The Nigerian valuation study, published in 2026 in Quality of Life Research, was conducted by researchers associated with the NHIA and Mahidol University.

Developing a Nigerian valuation set is relevant because health-economic assessments often need to translate changes in health status into measures that can be compared across interventions.

Using values reflecting the preferences of the Nigerian population can help assessments better reflect local circumstances.

The broader objective is to reduce reliance on assumptions derived entirely from other healthcare systems.

The Question of Cost and Value

One of the most important features of HTA is that it introduces economic analysis into healthcare decisions.

That does not mean that cost becomes the only consideration.

The NHIA's framework explicitly refers to clinical, economic, social, organisational and ethical dimensions.

The central question is how evidence can be used to understand the consequences of different choices.

For example, if two medicines produce similar clinical outcomes but one costs substantially more, an assessment can examine the reasons for the price difference and the implications for the health system.

If a new medicine is more expensive but produces additional health benefits, the assessment can examine whether those benefits justify the additional expenditure within the relevant decision framework.

If a diagnostic technology detects disease earlier, the assessment can examine whether earlier detection leads to improved outcomes and whether the health system has sufficient capacity to provide treatment after diagnosis.

The same principle applies to medical equipment.

Buying a sophisticated machine is only one part of the equation.

There may also be costs for installation, maintenance, electricity, specialist training, consumables and replacement parts.

A technology that performs well in a controlled environment may not deliver the same value if supporting infrastructure is unavailable.

HTA is designed to make these considerations visible before resources are committed.

Equity as Part of the Assessment

Nigeria's health system has substantial geographic and socioeconomic differences.

Access to healthcare can vary between urban and rural communities, between different states and between populations with different levels of income.

The NHIA says equity is one of the dimensions to be considered within its HTA approach.

That means the assessment of an intervention can extend beyond a simple calculation of average health outcomes.

Decision-makers may also need to understand who benefits and whether an intervention could widen or reduce existing disparities.

A service that is readily available in major cities may require additional investment before it can reach remote communities.

Similarly, a treatment requiring frequent hospital visits may create a different access burden for people living far from specialist centres.

These factors can be important when assessing how an intervention should be financed or incorporated into a benefit package.

The Role of Public Participation

The new steering committee has also been tasked with supporting stakeholder and citizen engagement.

That is relevant because healthcare decisions directly affect patients and communities.

Patients may have perspectives that cannot be fully captured through clinical trials or economic models.

For example, people living with chronic conditions may have practical knowledge about transportation, treatment schedules, side effects, caregiver burdens and other aspects of healthcare that affect whether a treatment can be used successfully.

Healthcare workers may identify implementation barriers.

Researchers may highlight evidence gaps.

Insurers may provide information on financial sustainability.

Regulators may identify safety and quality considerations.

Manufacturers may provide technical information about medicines or devices.

The NHIA's framework is intended to create a process through which these perspectives can be considered while maintaining methodological standards and safeguards.

Connection With Universal Health Coverage

Nigeria's HTA programme is being developed within the broader national objective of Universal Health Coverage.

WHO describes primary healthcare and UHC as involving access to needed health services without financial hardship, while health systems must address prevention, treatment, rehabilitation and other health needs.

For an insurance system, financial protection depends partly on how effectively available funds are used.

If resources are directed toward interventions that provide limited benefit while essential services remain underfunded, the overall system may struggle to meet its objectives.

The NHIA therefore sees HTA as part of its strategic purchasing reforms.

The Authority says the institutionalisation process is intended to make benefit-package and coverage decisions more systematic and transparent.

The goal is not simply to produce technical reports.

The NHIA has stated that the effectiveness of institutionalisation should ultimately be judged by whether HTA findings influence actual decisions about healthcare resources.

That distinction will be important as the programme develops.

From Assessment to Coverage Decisions

A completed HTA does not automatically mean that a treatment will be covered or rejected.

Instead, its findings can become part of a wider decision-making process.

Other factors may include available budgets, national health priorities, disease burden, implementation capacity, legal requirements and public-health considerations.

The NHIA's steering committee is expected to help establish pathways through which HTA evidence feeds into policy, benefit-package design, strategic purchasing and reimbursement.

This could eventually create a clearer connection between research and health-financing decisions.

Researchers can produce evidence.

The HTA process can analyse that evidence.

Decision-makers can then consider the findings alongside other policy priorities.

Healthcare purchasers can use the resulting decisions to guide reimbursement and procurement.

In theory, this creates a chain from evidence generation to policy implementation.

The effectiveness of that chain will depend on whether the findings are consistently considered when actual purchasing and coverage decisions are made.

Implications for Medicines

Medicines are likely to remain an important area for HTA because pharmaceutical spending can place significant pressure on health budgets.

New medicines can offer important clinical advances but may also enter the market at high prices.

For an insurance purchaser, the question is not simply whether a medicine has regulatory approval.

It is also whether the medicine's benefits, costs, safety profile and implementation requirements support inclusion in a publicly financed benefit package.

HTA can provide evidence for those deliberations.

Nigeria's pharmaceutical market has also been expanding, with population growth, urbanisation and increased healthcare demand contributing to rising demand for medicines. Premium Times reported in August that estimates of Nigeria's pharmaceutical market vary significantly, while over-the-counter medicines accounted for a large share of market activity in 2026.

A structured assessment system could therefore become increasingly relevant as more products compete for inclusion in insurance-financed care.

Implications for Cancer Care

Cancer is another area in which health technology assessment can become important.

Cancer care can involve diagnosis, surgery, radiotherapy, chemotherapy, targeted therapies, immunotherapies, supportive care and long-term monitoring.

Some treatments are highly specialised and expensive.

The NHIA's pilot assessment of sorafenib for advanced liver cancer shows that oncology is already within the scope of the programme.

Future assessments could potentially address other cancer interventions as Nigeria expands its cancer-control and health-insurance programmes.

The purpose would be to examine evidence in the Nigerian context and provide decision-makers with structured information.

For patients, the practical consequence of such systems could eventually be clearer rules around which treatments are financed, under what circumstances and through which purchasing arrangements.

Implications for Chronic Diseases

The growing burden of noncommunicable diseases also creates pressure for health financing systems.

People living with hypertension, diabetes, cancer and other chronic diseases may require healthcare over many years.

WHO's Nigeria office recently highlighted the importance of safe, coordinated and continuous care for people living with noncommunicable diseases during World Patient Safety Day 2026.

Long-term conditions create a different purchasing challenge from short episodes of illness.

Patients may require medicines, laboratory tests, specialist consultations and follow-up appointments over extended periods.

HTA can help policymakers assess not only individual treatments but also broader approaches to managing chronic diseases.

For example, a relatively inexpensive preventive intervention may avoid more costly complications later.

An assessment framework can help decision-makers examine those longer-term effects.

Digital Health and Technology

The HTA initiative is developing alongside another health-technology reform within the Federal Ministry of Health and Social Welfare.

The ministry inaugurated a steering committee for the National Health Technology and Data Analytics Office in September 2026.

The office is intended to coordinate, standardise and integrate health technology and data systems across Nigeria's health sector and promote interoperability, adoption and scaling.

The two initiatives have different immediate purposes.

The National Health Technology and Data Analytics Office is focused on digital transformation, technology coordination and health-data systems.

The NHIA's HTA programme is focused on evaluating health interventions and informing purchasing and coverage decisions.

However, the two areas can intersect.

Digital systems can generate data needed to evaluate healthcare technologies.

Better data can improve assessments of utilisation, costs, outcomes and access.

Conversely, HTA can provide a framework for evaluating whether new digital health technologies should be adopted and financed.

The Need for Reliable Data

The success of HTA depends heavily on evidence.

If information about disease burden, treatment outcomes, costs and service utilisation is incomplete, the conclusions of an assessment may be uncertain.

This makes health information systems an important part of the broader reform agenda.

Nigeria is already working on health data and digital coordination through multiple government programmes and agencies.

The Federal Ministry of Health's National Health Technology and Data Analytics Office is intended in part to improve coordination and integration of health technology and data systems.

For HTA, better data could support more accurate assessments of real-world healthcare delivery.

For example, knowing how often a treatment is used, how much it costs providers, how long patients remain on it and what outcomes they experience can strengthen future assessments.

The process is therefore connected to the quality of Nigeria's wider health information infrastructure.

Developing Local Expertise

Another challenge is the availability of specialists trained in health economics, epidemiology, clinical research, statistics, data analysis and related fields.

HTA requires multidisciplinary teams.

The NHIA has responded by supporting postgraduate training, including researchers studying HTA at Mahidol University in Thailand.

The longer-term objective is to develop a domestic pool of specialists who can conduct and critically assess HTAs.

Local expertise can also help ensure that assessments address Nigeria-specific conditions.

A model developed for a high-income country may assume different medicine prices, hospital costs, disease patterns, transport systems or health-service availability.

Nigerian researchers can adapt methods to local realities while maintaining international methodological standards.

Regulatory Coordination

The participation of the National Agency for Food and Drug Administration and Control in the steering committee is also significant.

NAFDAC has regulatory responsibilities relating to medicines, medical devices and other regulated health products.

HTA and regulatory approval are not the same thing.

Regulatory agencies primarily consider questions such as safety, quality and efficacy within their statutory mandates.

HTA examines broader questions about value, costs, comparative effectiveness, equity and health-system consequences.

The two processes can therefore provide different forms of evidence.

A medicine can receive regulatory approval while a separate HTA process considers whether and how it should be financed through a particular health benefit package.

The involvement of regulatory stakeholders can help strengthen coordination between these parts of the health system.

What Happens Next

The immediate task for the National HTA Steering Committee is to provide oversight and guide the development of the national system.

The NHIA says the committee will support prioritisation of HTA topics, strengthen methodological safeguards, encourage stakeholder engagement and develop pathways for findings to influence health policy and purchasing.

That means the next phase is likely to involve further assessments and refinement of the framework.

The pilot assessments provide an initial foundation.

The national framework provides the rules.

The steering committee provides governance.

The next test is whether the evidence generated through the system becomes part of routine decisions.

That could include decisions on medicines, medical equipment, diagnostic services, screening programmes and other interventions.

A Broader Financing Reform

The HTA programme forms part of a broader effort to improve how healthcare is financed in Nigeria.

The NHIA has also reported progress on interventions designed to reduce financial barriers to emergency maternal and newborn care.

According to the Authority's September 2026 mid-year review, more than 93,000 women and newborns had been reached by August through its financing interventions, including 79,221 mothers and 7,500 infants, while 6,044 women had received treatment for obstetric fistula. The NHIA also reported more than 40,000 women enrolled under the Basic Health Care Provision Fund, with 273 empanelled Comprehensive Emergency Obstetric and Newborn Care facilities and 22 fistula centres.

These programmes address immediate access to care.

HTA addresses another part of the financing challenge: how to determine which interventions and services should receive resources and under what conditions.

Together, the two areas illustrate the broader objective of building a health system that combines financial protection with more deliberate purchasing.

The Patient Perspective

Ultimately, the relevance of HTA will be measured at the level of patients and healthcare services.

For patients, evidence-based purchasing could eventually mean clearer decisions about which medicines, diagnostics and procedures are included in health insurance packages.

For healthcare providers, it could provide more structured guidance on reimbursable services and technologies.

For government and insurers, it could provide evidence to support difficult resource-allocation decisions.

For researchers, it creates opportunities to generate Nigerian evidence on health outcomes and costs.

For taxpayers and contributors to insurance schemes, the process is intended to improve accountability in how healthcare resources are used.

The NHIA has emphasised transparency, evidence and equity as core elements of its approach.

Challenges Ahead

Institutionalising HTA does not eliminate the difficult choices facing a health system.

Evidence may be incomplete.

Costs can change.

New medicines and technologies can enter the market rapidly.

Disease patterns can shift.

Budget constraints can change.

Health interventions can perform differently in real-world settings than in clinical studies.

There can also be disagreement over which outcomes should receive the greatest weight.

A national HTA system therefore needs transparent methods and clear governance.

The NHIA's decision to include conflict-of-interest safeguards, stakeholder engagement and public-interest representation in its framework reflects the need to address those challenges as the programme develops.

The system will also need to remain responsive as Nigeria's healthcare priorities evolve.

From Spending More to Spending With Evidence

Nigeria's health sector faces pressure to mobilise additional resources, but financing alone does not determine health outcomes.

How existing resources are allocated also matters.

The NHIA's institutionalisation of HTA is based on the premise that health financing decisions should increasingly be informed by evidence about effectiveness, costs, equity and implementation.

That could change the way healthcare purchasing decisions are approached.

Instead of asking only whether a treatment or technology exists, policymakers can also ask what health benefit it produces, what it costs, who benefits, whether alternatives exist and whether the Nigerian health system can deliver it effectively.

Those questions do not remove the need for political and policy choices.

They provide evidence for making those choices more transparent and structured.

Nigeria's Next Phase of Health Financing

The inauguration of the National Health Technology Assessment Steering Committee marks an important institutional development in Nigeria's health-financing reform agenda.

The NHIA has moved from developing an HTA concept to creating a dedicated division, building a national framework, training specialists, conducting pilot assessments and establishing a national governance structure.

The pilots covering kidney replacement therapy, colorectal cancer screening and advanced liver cancer treatment demonstrate that the approach can be applied to different types of healthcare decisions.

The Nigerian EQ-5D-5L valuation study adds another component by helping generate local evidence for health-economic analysis.

The next stage will be to determine how consistently that evidence influences actual decisions about coverage, reimbursement, procurement and pricing.

That will be the practical test of institutionalisation.

If HTA becomes part of routine health-financing decisions, it could provide Nigerian policymakers with a more structured way of comparing competing interventions and understanding their consequences.

If the process is supported by reliable data, local expertise, transparent governance and meaningful stakeholder participation, it could also contribute to the wider objective of Universal Health Coverage.

For patients, the most important outcome will ultimately be whether these reforms translate into access to effective healthcare without excessive financial hardship.

For the health system, the challenge will be ensuring that scarce resources are directed towards services that address Nigeria's health needs while remaining financially and operationally sustainable.

And for the NHIA, the work ahead is to move HTA from an emerging institutional framework into a functioning part of everyday health purchasing.

Nigeria has now established the structure.

The next phase is implementation.

By Simpson Global Media News Desk