When Olayiwola Johnson, a Lagos State civil servant, needed treatment for a recurring illness, he visited a hospital under the ILERA EKO Health Insurance Scheme. Like many public workers, his salary had been automatically deducted to cover his health insurance, and he expected affordable care in return.
The consultation went smoothly, but when it was time to collect his prescribed medication, the hospital pharmacy had only a few basic drugs available.
“They usually say there are no drugs once the prescription goes beyond paracetamol,” he said.
The Lagos State Health Management Agency (LASHMA), established in 2015, oversees ILERA EKO, a health insurance scheme designed to reduce out-of-pocket medical spending and move Lagos toward universal health coverage.
As of January 2026, the scheme had registered over 1.4 million residents across a network of 449 healthcare providers.
The health insurance programme is increasingly powered by digital systems designed to simplify registration, verify enrollees, and provide remote access to healthcare services.
These initiatives align with Nigeria’s evolving Digital Public Infrastructure (DPI) ecosystem, which connects digital identity systems, phone numbers, and government databases to improve public service delivery.
To improve efficiency, LASHMA introduced a range of digital tools:
• Online registration through LASHMA’s websites
• Self-registration through the USSD code *6700006#
• Online premium payment portals
• A mobile application for enrollment and account management which can be downloaded from mobile app stores.
However, despite being enrolled in a system increasingly described as “digitally enabled,” Johnson had never used any of its digital services. He usually visits the hospital for consultations and treatment.
His experience reflects the gap between Digital Public Infrastructure (DPI) as designed and public services as experienced.
DPI In Health: Ambition Meets Implementation
The Lagos State Commissioner for Health, Prof. Akin Abayomi, said the initiative forms part of efforts to modernise healthcare delivery in the state.
“Our goal is to change health standards in Lagos to meet international health standards around the world,” he said.
But interviews with enrollees reveal a different reality: many beneficiaries are unaware of these digital services or do not use them, raising questions about how effectively the technology is reaching those it was designed to serve.
Adenike Adedeji had enrolled in the ILERA EKO Health Insurance Scheme hoping it would make healthcare easier and cheaper for her family. But like many patients in the busy clinic that Wednesday, Adedeji had spent two hours waiting to see a doctor.
“I always have to come to the hospital,” she said quietly. “I have never used the telemedicine platform.”
Adedeji also said she often spends additional money on medications because some prescribed drugs are not available at hospitals under the scheme.
Another enrollee, Fatima Sheriff, said she had never used the digital platforms nor has she faced discrimination under the scheme but experienced delays when a prescription clearance expired before she arrived at the pharmacy.
For other residents, the experience has been more positive.
Lateefat Abubakar, who registered under the scheme in 2024 at Gbagada General Hospital, said she used the programme for antenatal care and delivery.
“I used their services for antenatal and delivery and I was satisfied, although I don’t know about telemedicine”, she said.
In theory, ILERA EKO reflects core DPI principles like, inclusion (multiple access channels (USSD, mobile, web), interoperability (integration with identity databases), user-centricity (remote care via telemedicine). In practice, however, these principles are unevenly realised.
Digital Identity as a Healthcare Gateway
One of the most significant components in ILERA EKO is biometric verification.
In 2025, LASHMA deployed biometric card readers across 100 facilities under the ILERA EKO Social Health Plan.
The devices integrate with the database of the Lagos State Residents Registration Agency (LASSRA), allowing hospitals to authenticate patients using their resident identity records.
This reflects a foundational DPI principle, trusted digital identity as a gateway to services.
According to LASHMA’s Permanent Secretary, Dr Emmanuella Zamba, the technology is intended to prevent impersonation and ensure that healthcare services reach the right beneficiaries.
“This innovation strengthens the integrity of our health insurance system and ensures the right individuals receive care without delay,” she said.
Telemedicine: Healthcare Without Hospital Walls
LASHMA has introduced telemedicine services.
Through EKOTELEMED, ILERA EKO expands access to care and offers remote consultations via phone, chat, and video, alongside virtual consultation booths in selected markets.
The Permanent Secretary of LASHMA, Dr Zamba, said the service covers medical advice, mental health counselling and follow-up consultations.
She noted that virtual consultation booths have also been installed in five selected markets where residents can check basic health indicators and connect with doctors remotely.
Yet some enrollees are unaware.
Experts Say Awareness Is the Missing Link
Public health advocates say the issue is not infrastructure, but awareness and trust.
Mayowa Adeniran of the Media Action for Public Health Initiative said digital health platforms can significantly improve healthcare access if residents know how to use them.
“We are now in a digital world where many Lagos residents use mobile phones linked to their digital identities,” he said.
“If telemedicine is properly promoted, many people can access healthcare without leaving their homes or workplaces.”
Adeniran also suggested that LASHMA should promote testimonies from satisfied users, which could encourage more residents to trust the system.
He further proposed exploring compensation options for enrollees who pay premiums but do not use the scheme within a year.
To increase awareness, the LASHMA launched ILERA EKO Spotlight, an online radio platform dedicated to health insurance education and digital health promotion.
LASHMA Defends the System
Responding to concerns raised by some enrollees, the Permanent Secretary of LASHMA, Dr Zamba, said the initiative’s digital platforms are fully operational.
“The entire chain of care is digitally enabled, from registration to service delivery,” she said.
She explained that a temporary system shutdown previously experienced occurred during routine maintenance.
“Just like banking platforms, digital systems sometimes go down briefly for upgrades. The portal has since been restored and is functioning normally,” she added.
On telemedicine services, she said consultations are available 24 hours a day.
“You can call the toll-free line and speak to a doctor at any time. You can also download the telemedicine application for audio or video consultations,” she said.
She added that the agency would intensify awareness campaigns to ensure more residents become familiar with the telemedicine service and take advantage of it.
Dr Zamba also encouraged enrollees to report challenges through the agency’s call centre and other customer service channels. She emphasised that enrollees have the right to understand the benefits included in their chosen package.
“If any service, including prescribed medications, is denied, enrollees should promptly report the incident to the Lagos State Health Management Agency so that appropriate action can be taken,” she said.
“You have rights as an enrollee. If a facility denies you services you are entitled to, report it to us and we will take action,” she added.
Dr Zamba assured that the protection of enrollees’ data remains a priority for the agency. She said Lagos State places strong emphasis on safeguarding residents’ data and that the Lagos State Health Management Agency (LASHMA) fully aligns with this standard.
According to her, the agency’s digital systems are well secured and have not experienced any case of data breach since their deployment.
Across Nigeria, governments are increasingly adopting DPI to deliver social services.
Health experts say Lagos State’s digital health insurance mode offers an important test case.
NOTE: The civil servant’s names in this story are pseudonymous.
This report is produced under the DPI Africa Journalism Fellowship Programme of the Media Foundation for West Africa and Co-Develop
