A Scoping Review of the Impact of State-Developed Health Insurance Schemes on Healthcare Accessibility, Financial Stability, and Healthcare Outcomes: A Focus on ILERA EKO, a Lagos State Insurance Initiative, Nigeria

Abstract Introduction Health insurance schemes are fundamental in mitigating financial healthcare barriers and advancing universal health coverage (UHC); however, Nigeria faces low enrollment rates, with over 70% of healthcare expenditures being funded through out-of-pocket payments. This study evaluates the impact of Lagos State’s ILERA EKO Health Insurance Scheme, a state-led initiative launched in 2022, on healthcare accessibility, financial protection, and health outcomes, offering insights into its role within Nigeria’s fragmented health system. Methodology A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework. Systematic searches across PubMed, Scopus, CINAHL, and grey literature (e.g., Lagos State government reports, World Bank documents) identified 780 studies, with 11 meeting inclusion criteria focusing on themes such as enrollment barriers, equity in access, and governance challenges. Results ILERA EKO improved healthcare access for low-income populations, with insured individuals reporting 40% lower out-of-pocket expenditures. Maternal health services and chronic disease management saw notable gains, including increased antenatal care attendance. However, enrollment remains low (15% coverage), hindered by bureaucratic inefficiencies, limited public awareness, and funding gaps. Geographic disparities persist, with rural Lagos residents facing persistent access barriers despite the scheme’s objectives. Discussion While ILERA EKO shows a strong indication as a tool for financial risk protection, its impact is constrained by structural challenges, including fragmented funding and inadequate integration with private providers. Lessons from Ghana’s NHIS suggest that decentralizing enrollment and leveraging community health workers could improve adoption. Future research should prioritize mixed-methods evaluations to assess long-term health outcomes and cost-effectiveness. Policymakers must address administrative bottlenecks and expand public awareness campaigns to realize the scheme’s UHC ambitions in Lagos State and comparable LMIC settings. Conclusion The scoping review determined that the ILERA EKO Health Insurance Scheme has enhanced healthcare accessibility and reduced financial barriers for Lagos State residents, particularly among marginalized/vulnerable populations. However, its impact on health outcomes remains mixed, with quality of care and provider reimbursement challenges persisting. Addressing infrastructural gaps, ensuring timely provider payments, and strengthening scheme sustainability are critical to maximizing its long-term benefits. These findings offer policy-relevant knowledge for refining state-led health insurance models in Nigeria and low- and middle-income countries.