TRAINING NEEDS ASSESSMENT OF STAKEHOLDERS IN THE HEALTH INSURANCE INDUSTRY IN SOUTHWEST REGION OF NIGERIA: IMPLICATIONS FOR UNIVERSAL HEALTH COVERAGE

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D.A Adewole¹ , S. Bello² ,A.S. Oginni³

1. Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
2. Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
3. Osun Health Insurance Agency, Osogbo, Osun State, Nigeria.

Abstract

Background: The coverage of the social health insurance scheme in Nigeria has been low. The scheme may benefit from personnel training which has been shown to improve organisational performance.

Objective: This study, therefore, aimed to assess the training needs of personnel in the health insurance industry in Southwest Nigeria.

Method: This was a cross-sectional survey conducted among personnel of the health insurance industry in Southwest of Nigeria. The survey tool adapted was the Hennessy-Hicks Training Needs Analysis Questionnaire. The tool has been psychometrically tested for validity and reliability. Originally, the tool has 30 items with an allowance for modification without compromising its psychometric properties. The 30 items were grouped into six superordinate categories; management/supervisory, administration, clinical/service delivery assessment, communication/ teamwork, facility financial audit/assessment, and facility infrastructure assessments. Respondents rated each item along two seven-point scales. In the first scale, respondents rated how important (importance rating) the item is to their job while in the second scale, respondents self-rated their current performance level of the item (performance rating). A training need index was generated by subtracting performance rating from the importance rating for each of the six superordinate categories.

Results: Training needs for each of the six subcategories ranked by the magnitude of the derived training need index (from highest to lowest) were; clinical/service delivery, facility infrastructure, facility financial audit, management/supervisory skills, communication, and teamwork, and
administration.

Conclusions: Training need was demonstrated in all six subcategories. Emphasis on the relevant training need of personnel in the health insurance industry in Nigeria is important to improve efficiency and performance.

Keywords: Training needs, Hennessy-Hicks, Health insurance, Universal health coverage, Nigeria

Introduction

The low level of population coverage by health insurance schemes in developing countries is a concern for stakeholders globally.¹ Many factors have been attributed to this scenario, among which are the characteristics of the potential beneficiaries of such schemes, for example, poverty, low trust in the integrity of public policies, and poor understanding of schemes among others. ^1,2 Factors of the contextual environments such as the political institutions and structure,^3-6 weak health systems, and population characteristics, which is, formal and informal^1,7,8 have also been cited. Likewise, important skills required for a successful implementation of a health insurance scheme such as technical, administrative (or managerial) capacities of the personnel in the health insurance industry who are the ‘drivers’ of the schemes have been referred to as contributory factors.

The transition period to universal health coverage (UHC) differs from country to country, especially in Europe, Asia, and Latin America, while some lasted about a century, some others were able to achieve UHC in a few decades.⁹ Encouraging reports have been documented in some African countries. ^[1] Estimates have stipulated gradual transition to UHC at 60-80% over nine years after implementation. In Nigeria, the social health insurance scheme was implemented in 2005, the same period as in Ghana. However, while current population coverage in Nigeria is abysmally low at less than 10%, present population coverage in Ghana, is more encouraging at about 40%.¹¹

Technical and managerial capacities of personnel in organisations have been shown to improve with training.^12-16 In addition to capacity building, training, also improves employees’ creativity for better decision making and productivity, which eventually enhances organisational productivity.^17,18 Training programmes could take the form of structured formal types linked with background educational qualifications, on-the-job non-structured types organized by and carried out during routine workplace activities among other types.^{19, 20}

Studies on the low population coverage of the scheme in Nigeria have been focused most of the time on factors other than training.^2,3,5 Very few if any, have researched other contributory factors to low population coverage of the scheme such as the capacities and skills need of the ‘drivers’ of the scheme. This study was carried out to assess the capacity and training needs of personnel of selected major stakeholders in the health insurance industry in the Southwest of Nigeria. Findings will contribute to the efforts to improve population coverage under the scheme in Nigeria and similar other countries