National Health Insurance Management Authority

What National Health Insurance Management Authority does

National Health Insurance Management Authority (NHIMA) is a statutory government body established under Zambia's National Health Insurance Act No. 2 of 2018 and headquartered in Lusaka. Its core function is to administer and regulate the compulsory National Health Insurance Scheme (NHIS), under which eligible Zambians are enrolled and required contributors. As Director General, Dr. Michael K. Njapau leads an organization of 251–500 employees operating through 13 provincial and regional offices spanning the country.

NHIMA's product surface centers on the eNHIMA digital platform, which supports electronic claims submission (98% of claims), 48-hour pre-authorization turnaround, and integrated payments via mobile money and commercial banks. Over 450 accredited healthcare facilities — spanning public, private, faith-based, mining-sector, and pharmacy providers — are connected to this network, and more than 7 million claims have been processed to date. Member-service metrics reported by the Authority include 96% complaint resolution and 98% query resolution.

Revenue is generated through mandatory payroll contributions of 1% from employees and 1% from employers in the formal sector, progressive income-assessed contributions from informal-sector participants, healthcare provider accreditation fees, and statutory penalties. NHIMA supplements these revenue streams with multi-ministry arrangements to extend coverage to vulnerable populations, including persons with disabilities, prisoners, refugees, and informal traders. Member scale exceeds 5 million registered individuals (3.5 million principal members plus 1.5 million beneficiaries).

Name

National Health Insurance Management Authority

Legal name

National Health Insurance Management Authority

Website

https://nhima.co.zm

Company type

Private

Founded year

2018

Operating status

Operating

Headcount range

251–500 employees

Short description

National Health Insurance Management Authority administers Zambia's compulsory National Health Insurance Scheme under the NHI Act 2018, enrolling 5M+ members and accrediting 450+ healthcare providers through 13 provincial offices, funded by payroll contributions, fees, and penalties.

Ownership category

akta.pro rank

Product category

National Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Insurance and Employee Benefit Funds (5251), Administration of Public Health Programs (923120)

SIC

Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)

akta.pro industry

PRIMARYBPAIAKAH

Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage)

Business & Public Services/Public Sector & Government Administration/Social Security, Benefits & Welfare Administration

SECONDARYHLAEAMAC

Network-Model HMOs

Healthcare & Life Sciences/Health Insurance & Managed Care/Health Maintenance Organizations (HMOs)

SECONDARYHLAEALAF

Utilization Management (Prior Auth/Medical Necessity) Administration

Healthcare & Life Sciences/Health Insurance & Managed Care/Third-Party Administration (TPA) & Administrative Services Only (ASO)

Keywords

• National health insurance
• Social health insurance
• Healthcare financing
• Health insurance administration
• Universal health coverage

Headquarters

HQ city

Lusaka

HQ country

Zambia

HQ region

Africa

Offices13 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales

Revenue model

1. Formal Sector Premium Contributions: Monthly premium contributions from employed individuals: 1% of declared income contributed by the employee and 1% employer contribution from basic salary. Premiums are due for remittance by the 10th of each month.
2. Informal Sector Premium Contributions: Self-employed and informal sector members pay premiums assessed using the eNHIMA income assessment tool. Contributions are calculated based on income evaluation.
3. Healthcare Provider Accreditation Fees: Annual accreditation fees charged to healthcare facilities: Hospital/Hospice at ZMW 12,000 per year; Laboratory, Diagnostic Centre, Pharmacy, and Clinic at ZMW 6,000 per year.
4. Penalty Fees for Non-Remittance: Penalties levied at 10% of outstanding monthly total contribution, subject to maximum amount of K60,000.00, to compensate against lost investment gains, inflation, and breach of compliance penalty charge.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels11 records

Core offering

NHIMA administers Zambia's compulsory National Health Insurance Scheme (NHIS), delivering healthcare financing coverage for citizens and established residents through mandatory monthly premium contributions and accreditation of healthcare providers. The Authority runs the eNHIMA digital platform for member registration, premium payments, and electronic claims processing, and offers a comprehensive benefit package covering pharmaceuticals, surgeries, maternity, dental, vision, oncology, and rehabilitation services delivered through 450+ accredited providers.

Product overview

National Health Insurance Management Authority (NHIMA) operates the compulsory National Health Insurance Scheme (NHIS) as a unified social health insurance system for Zambia. The core product consists of the NHIS providing healthcare financing coverage for citizens and established residents. The eNHIMA digital platform serves as the primary interface for member registration, claims processing, premium payments, and provider management. The benefit package defines covered services across pharmaceutical drugs, laboratory and radiology services, dental care, vision care, maternity services, surgeries, and oncology. Over 450 accredited healthcare providers form the provider network. Additional services include member ID management, healthcare provider accreditation, claims processing with 98% electronic submission, complaints resolution, and premium collection from formal and informal sectors.

Differentiator

Problem solved

Functional benefit

Quantifiable outcome

• Over 5,000,000 members registered including 3.5 million principal members and 1.5 million beneficiaries
• +4 more outcomes

Named customers3 records

Segments5 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration8 records

Feature1 record

Partnerships

Ten partnerships are on record, tiered core and minor.

• International Social Security Association (ISSA)coreStrategic or Co-development Partner · 22 April 2026NHIMA participated in ISSA's Customer-Centric Digital Transformation workshop held in Victoria Falls, Zimbabwe from April 22-24, 2026. The workshop, organized by ISSA Southern Africa Liaison Office and hosted by NSSA Zimbabwe, brought together institutions across Southern Africa to exchange insights on digital transformation and service delivery in social security.
• Ministry of Health (Zambia)coreStrategic or Co-development PartnerNHIMA is anchored in the Ministry of Health and works under its oversight. The Ministry provides regulatory guidance and alignment with national health policy objectives for Universal Health Coverage.
• Ministry of Labour and Social SecurityminorOthersNHIMA collaborates with the Ministry of Labour and Social Security on labour-related matters including domestic worker registration and compliance.
• Ministry of Community Development and Social ServicescoreOthersThe Ministry identifies and registers poor and vulnerable populations who receive NHIMA coverage. This partnership ensures universal health coverage reaches marginalized citizens.
• Mobile Network Operators (MNOs)coreTechnology or IntegrationAll mobile network operators in Zambia have been integrated with NHIMA for mobile money payments and membership status checks, enabling convenient premium payments and verification for members.
• Zanaco BankcoreChannel Partner/ Reseller/ DistributorZanaco provides payment processing services through Cyber Source for NHIMA premium payments and member transactions.
• Investrust BankminorChannel Partner/ Reseller/ DistributorInvestrust Bank serves as a payment channel for NHIMA premium collections and member transactions.
• ABSA Bank and Access BankminorChannel Partner/ Reseller/ DistributorABSA and Access Bank provide online banking payment channels for NHIMA premium payments.
• First National Bank (FNB)minorChannel Partner/ Reseller/ DistributorFNB provides online banking payment services for NHIMA premium collections.
• SpennminorChannel Partner/ Reseller/ DistributorSpenn provides alternative payment processing for NHIMA member transactions.

Scale indicators7 records

Recent moves8 records

Expansion highlights6 records

Broad incumbents

• NHS England: Administers universal health coverage for England via tax-funded, mandatory enrollment — analogous to NHIMA's statutory UHC mandate, though NHS is largely a direct provider rather than a pure purchaser.
• Centers for Medicare & Medicaid Services (CMS): U.S. federal agency administering Medicare and Medicaid — analogous social health insurance programs with mandatory/subsidised coverage and provider accreditation frameworks, although at vastly greater scale.

Regional players

• RSSB (Rwanda Social Security Board): Rwanda's statutory social security administrator covering health insurance alongside pension; comparable East-African context, mandatory enrollment via formal sector and community-based health schemes (CBHI), with strong digital enrolment.
• NHIS Tanzania (National Health Insurance Fund): Tanzania's statutory health insurer operating iCHF and NHIF schemes with formal-sector mandatory contributions and accredited providers — comparable regional peer operating a similar social health insurance model.

Emerging players

• AAR Healthcare Kenya: Private healthcare and insurance provider in East Africa operating accredited clinics and insurance products; relevant peer because it works within national insurance schemes like NHIF, mirroring NHIMA's accredited-provider dynamics.
• National Health Insurance Company – Daman (UAE): UAE's leading health insurer operating Thiqa and other plans with mandatory enrollment and digital claims/pre-authorisation, comparable to NHIMA in using electronic pre-auth and provider accreditation at scale.

Direct peers

• BPJS Kesehatan (Indonesia): Indonesia's national social health insurance administrator managing JKN, the world's largest single-payer scheme, with mandatory contributions, provider accreditation, and digital claims processing — directly comparable in scale ambition to NHIMA.
• PhilHealth (Philippine Health Insurance Corporation): National health insurer of the Philippines implementing universal health coverage via premium-based mandatory enrollment and accredited provider network, with comprehensive benefit packages — closely comparable to NHIMA's UHC architecture.
• National Hospital Insurance Fund (NHIF) Kenya: Kenya's statutory health insurer collecting monthly contributions from formal sector employees and accrediting providers nationwide. Highly comparable in mandate, contribution mechanics, and provider-network model.
• National Health Insurance Authority (NHIA) Ghana: Operates Ghana's National Health Insurance Scheme, a statutory social health insurance system with mandatory enrollment, provider accreditation, and electronic claims — closely analogous to NHIMA's operating model in Zambia.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/nhima_
• YouTubeyoutube.com/@nationalhealthinsuranceman6552
• Facebookweb.facebook.com/NHIMAZM
• LinkedInlinkedin.com/company/national-health-insurance-management-authority

Revenue estimate

Valuation estimate

Number of profiles

Profiles19 records

Funding overview

Funding rounds

Investors

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M&A

Investments

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Frequently asked questions about National Health Insurance Management Authority