Professional Design of a Data Quality Management Framework for the National Health Insurance Authority

The National Health Insurance Authority manages enrolment, claims, and provider data for millions of Nigerians, and a systematic data quality management framework would significantly improve data reliability for policy decisions and fraud prevention. This study designed a data quality management framework for NHIA, drawing on assessment of current data quality issues across enrolment, claims, provider registration, and premium payment datasets. A professional framework development methodology was employed with structured interviews with 15 NHIA data managers and claims analysts, documentary review of NHIA IT architecture, and benchmarking against ISO 8000 data quality standards and HMIS data quality frameworks used by WHO in sub-Saharan Africa. Assessment identified duplicate enrolment records (estimated 8.4 percent of records), incomplete facility codes in claims data (23.7 percent missing), and systematic date formatting inconsistencies as the three highest-priority data quality issues. The framework specifies six data quality dimensions (accuracy, completeness, consistency, timeliness, uniqueness, and validity), automated data profiling procedures, error classification and escalation protocols, data steward roles, and a quarterly quality scorecard for NHIA management reporting. Expert review by eight health data management specialists confirmed the framework's comprehensiveness and NHIA operational applicability. The study recommends NHIA adopt the framework as the data governance standard for the Universal Health Coverage data ecosystem, with immediate deployment of automated duplicate detection as the first operational priority.

Keywords: data quality management, NHIA, health insurance, data governance, Nigeria