Institutional and Administrative Barriers to the Implementation of the National Health Insurance Authority (NHIA) Policy in Plateau State

Despite the establishment of the National Health Insurance Authority (NHIA) to promote equitable access to healthcare and financial protection for Nigerians, its effective implementation in Plateau State continues to face persistent institutional and administrative challenges such limited institutional capacity of the NHIA office, characterized by understaffing, insufficient logistics, and weak technical coordination. The study adopted Elite Theory of Public Policy propounded by Vilfredo Pareto in 1896. The population comprised 148 staff of the NHIA in Plateau State, from which a sample size of 107 was determined using Krejcie and Morgan’s (1970) formula. Data were collected using a structured questionnaire, and 91 valid responses were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Findings revealed that institutional and administrative barriers significantly influence the effective implementation of the NHIA in Plateau State. A large majority (82.5%) of respondents identified corruption and mismanagement of resources as key constraints. Similarly, weak monitoring and evaluation mechanisms (80.3%) were highlighted as major challenges, Furthermore, inadequate infrastructure (82.5%) and funding constraints (74.8%) were found to impede service delivery, corroborating. Political interference (86.8%) and legal gaps (75.8%) further weakened institutional effectiveness. Conversely, the study found relative strengths in administrative coordination between NHIA headquarters and the Plateau State office, leadership stability, staff competence, and digital record management. The study recommended stronger accountability systems, improved funding mechanisms, enhanced infrastructure, digitalized monitoring frameworks, and continuous capacity-building programs. Ensuring merit-based leadership appointments and enforcing regulatory compliance are also essential to achieving sustainable universal health coverage in Nigeria.