Tzar Oluigbo (Lead writer)
Across Nigeria, December has its own rhythm. Flights are packed, roads are busier, and plans for family reunions, weddings, and “just one more” trip before the year ends pile up quickly. The spirit is festive and joyful, and the country feels alive. December is also a month of long journeys, late nights, crowded spaces and surprises where things do not always go according to plan.
However, Detty December comes with the kind of unpredictability people rarely plan for, such as sudden illness, accidents on the road, foodborne infections, and emergency bills that can wipe out a month’s worth of celebration in one night. In moments like these, preparation matters just as much as planning the fun. In the middle of all the movement and excitement, health insurance should not be an afterthought; it can be the difference between panic and prompt care.
Out-of-pocket spending turns health shocks into financial crises
In Nigeria, that difference is clear. 76% of current health expenditure is paid out-of-pocket. This means that most families must pay directly for care at the point of need, often without savings or financial protection. With health insurance reaching only a small fraction of the population, many households face medical bills that compete directly with food, rent, and school fees.
A few days before Christmas last year, an incident changed my attitude to end-of-year celebrations. The church was full, families returning home, children rehearsing for their Christmas carol presentations, and travellers stopping by for one last church service before hitting the road. In the middle of all that joy, a woman stepped out of the hall holding her daughter who was coughing non-stop. At first, it seemed minor, but within minutes, the girl became weaker, and her mother began to panic. People gathered around, and someone asked the question we don’t say loudly but often think: “Which hospital can she go to now and how much will it cost?” This question stayed with me long after the service ended.
The cost barrier is documented, not subjective
Evidence shows that millions of Nigerians delay or avoid seeking care because of cost, even when symptoms are serious. The World Bank estimates that healthcare payments push over two million Nigerians into poverty every year, turning preventable or manageable conditions into financial shocks. December is exciting, yes, but it is also fragile. And that fragility becomes clearer when you see how quickly a simple health concern can grow into a financial crisis. We plan for travel, clothes, and family gatherings but are rarely prepared for illness. This is why holiday health planning matters more than we think.
Seasonal changes such as harmattan, which typically runs from November to March, are not just uncomfortable; they also increase demand for healthcare. Harmattan triggers allergies, asthma flare-ups, and respiratory infections, especially in children and older adults. Yet for uninsured families, even basic consultations and medications can mean unexpected spending at a time when household costs are already stretched.
Why health insurance must become a norm in Nigeria
Nigeria has made policy commitments to change this reality. The National Health Insurance Authority (NHIA) Act provides for mandatory health insurance for Nigerians and expands channels for enrolment. However, coverage remains low, with just over 10% of Nigerians currently enrolled in any form of health insurance, a sharp contrast to other African countries such as Ghana, where more than 60% of the population is covered, and Rwanda, where over 90% have health insurance through community-based and national schemes.
In September 2025, a presidential directive requiring the mandatory implementation of health insurance across Ministries, Departments, and Agencies (MDAs) signalled renewed political will to move the policy from paper to practice. Yet implementation remains uneven, awareness is limited, and many Nigerians still navigate the health system without knowing what health insurance options exist or how to use them.
To translate this directive into real protection, the Nigerian government needs to make health insurance easy to find, enrol, and use. Government should create a single national “entryway” with a clear channel to find your scheme, choose a provider, pay, and use care in accredited facilities. Health Maintenance Organisations’ (HMOs) should publish clear benefit and complaints guides in English and major Nigerian languages. Enrolment should include options for USSD/WhatsApp and community agents with flexible micro-payment plans. Health facilities should also have functional health insurance desks and provide tangible support when needed.
After that incident last December, I kept thinking about the mother’s whispered question: “Where can we afford to go?” It is a question far too common in Nigeria, one that people ask when they should be focusing on getting help not counting the cost. With out-of-pocket payments still dominating Nigeria’s health system and health insurance coverage lagging national targets, the cost of being unprepared is high. The result is a cycle where illness becomes not just a health problem, but a financial problem, often at the worst possible moment.
Make health insurance the real Detty December flex
Use this as your holiday health planning checklist:
- If you are enrolled, confirm that your plan is active and your premium is up to date. If you are not enrolled, start enrolment now through your employer, a state-supported scheme (where available), or an accredited HMO.
- Ensure your spouse/children/parents are registered on the plan so you are not negotiating eligibility during an emergency.
- Identify at least two health facilities (primary and backup) in your destination city and save their numbers.
- Ask for your benefit package in writing, including consultations, lab tests, admissions, medication, maternity, emergencies, and any exclusions.
- Keep your NHIA/ HMO identification, membership number, and customer care lines in your phone, and a printed copy in your travel wallet.
The end-of-year holidays is meant to be joyful, not financially draining. The point of health insurance is that is turns unpredictable health shocks into predictable, manageable costs. No Nigerian should have to choose between treatment and tomorrow’s rent, especially not in December.