D.A. Adewole1, M.D. Dairo2, V.N. Shaahu3, and S.A. Olowookere4

  1. Department of Health Policy and Management, College of Medicine, University of Ibadan, Nigeria.
  2. Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria.
  3. Department of Community Medicine, Federal Medical Centre, Makurdi, Nigeria.
  4. Department of Community Health, Obafemi Awolowo University, Ile–Ife Nigeria.


Background: The National Health Insurance Scheme (NHIS) in Nigeria has succeeded in enrolling only a minute fraction of the population. Studies on the scheme among informal sector employees are required to plan a scale up of the programme in this group which represents the majority of the working population in the country.

Objective: This study sought to assess the method of payment for health care,
awareness of and the perception about the NHIS among auto-technicians in Abuja, Nigeria.

Method: A cross-sectional descriptive survey was conducted among auto-technicians in Abuja Municipal Area Council (AMAC), Nigeria. Data was collected using interviewer-administered questionnaire, and analyzed with SPSS version 17.

Results: A total of 351 auto-technicians and allied workers participated in the study. Post-secondary education [(Odds Ratio (OR) = 7.78, 95% CI = 1.61 – 37.54, p = 0.01)] and having a spouse who is gainfully employed [(OR = 3.67, 95% CI = 1.04-12.93)] predicted awareness of the NHIS. Older people above forty years of age were significantly less likely to be aware of the NHIS, (OR = 0.27, 95% CI = 0.08 – 0.92, p = 0.036).

Conclusions: Despite the glaring need and willingness of the participants to enroll in a prepayment scheme for health, workers in the informal sector of the economy may remain unreached by NHIS due to lack of awareness and skepticism. Strategic steps to remove ignorance and dispel doubts is imperative for scale up of the NHIS in the informal sector.

Keywords: National Health Insurance Scheme, Awareness, Perception, Auto-technicians


Dr. D.A. Adewole
Department of Health Policy
and Management,
College of Medicine,
University of Ibadan,


In agreement with the WHO’s goal of ‘Health for All’, Universal Health Coverage (UHC), which is defined as access to key health interventions for all at an affordable cost to achieve equity of access, policymakers are making efforts to design locally appropriate strategies of financing health care in order to accomplish this. Social health insurance (SHI), a prepayment method for funding health services, is one of the initiatives to promote universal health coverage.1,2 Ghana, Rwanda and Kenya are some of the countries in the sub-Saharan Africa (SSA) that has promising SHI schemes. In these countries and in many others in the SSA, the major challenge has been in the implementation of sustainable SHI schemes especially in the informal sector. A large informal sector with low revenue generation capacity to meet basic human needs including health care, are some of the factors that makes the establishment of SHI schemes difficult in SSA.1,3 These are in addition to a low level of awareness and understanding of the concepts of SHI on both the demand and the supply sides.1,3,4 However, studies have shown that awareness and understanding health insurance schemes and a better socio-economic status predicts enrolment in a scheme.5 Implementation of a scheme that is both unknown and or not well understood among and for a group of potential beneficiaries is a recipe for failure.

In Nigeria, the National Health Insurance Scheme (NHIS) as a corporate body was established in 2005. The scheme was established to provide social health insurance to participating contributors; and to ensure that every Nigerian has access to health care at an affordable cost. It is a tripartite public – private partnership between the NHIS (Government Agency) which contracts the Health Maintenance Organisations (HMOs) that in turn purchase health care services from healthcare providers on behalf of the NHIS for the scheme’s beneficiaries. The HMOs get paid by the NHIS for its services. However, since its inception, the enrolment of Nigerians in the scheme has been low and mainly limited to the formal sector workers and their family members. Presently, only about 3.0% (5 million of 170 million) Nigerians are benefiting from the scheme.6

Most employees in the non- formal sector are engaged in the small and medium scale enterprises, majority of them have low and irregular income, and awareness and understanding of the concept of health insurance is low amongst them.7 Like the majority of the people in Nigeria, payment for health care services is made through other means than prepayment schemes with attendant characteristic poor health outcomes in the Country.6 As the larger sector in Nigeria, there is a need to integrate this workforce into the existing SHI scheme. This will facilitate the achievement of the desired universal health coverage.1 The NHIS encourage formation of informal trade unions into groups as platforms for enrolment into the scheme.

This informs a focus on auto-technicians who are found in organized groups, in small and big cities and towns, both rural and urban types in Nigeria. Effective planning for integration of this sector requires baseline information on potential participants’ awareness and willingness to access such schemes. Thus, this study sought to assess the awareness and perception of this trade group about prepayment schemes as it is currently available through the NHIS. This is important to appreciate existing gaps and thus to appropriately address them.