NATIONAL HEALTH INSURANCE SCHEME: PERCEPTION AND PARTICIPATION OF FEDERAL CIVIL SERVANTS IN IBADAN

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O.O. Akinyemi¹ , O.F. Owopetu² , and I.O. Agbejule¹

1. Department of Health Policy and Management, College of Medicine, University of Ibadan. 
2. Department of Total Quality Management, University College Hospital, Ibadan.

Abstract

Introduction: The National Health Insurance Scheme is a social health insurance programme designed by the Federal Government of Nigeria to complement sources of financing the health sector and to improve access to health care for the majority of Nigerians. Presently, the enrolment level on the Scheme is majorly among those in the formal sector and user experiences have been different. This study seeks to determine the perception and participation of Civil Servants regarding the National Health Insurance Scheme in Ibadan. 

Methods: A descriptive cross-sectional study was conducted among 273 civil servants working at the Federal Secretariat, Ikolaba, between October and November 2015. An interviewer-administered questionnaire was used to collect information on socio-demographic characteristics, awareness, and membership of the NHIS, perception of NHIS, and health-seeking behaviour. Participation was defined as the number of civil servants registered or enrolled under the scheme, in other words, members of the scheme. Information on perceptions was sought using a 3-point Likert scale. Descriptive statistics and chi-square tests were used for data analysis at a 5% level of significance. 

Results: About 60.1% of the respondents were males. The average age was 39.7+9.1 years, with 85.0% of the respondents being married. The majority (65.2%) of the respondents were mid-level cadre workers, 17.62% were working as senior-level workers and the remaining 17.6% were low cadre workers. The majority (88.9%) completed tertiary education, while just 11.1% completed basic education. The mean household size was 2.5+0.6. Awareness of the National Health Insurance Scheme was very high (95.2%) with 83.5% enrolled under the scheme. About (50%) of the respondents joined the scheme because it is cheap and affordable. There was a significant association between awareness, level of education, knowledge of NHIS, and registration into the scheme by respondents. The majority of the respondents (87.3%) claimed that NHIS is a better means of settling healthcare costs than Out-of-pocket-payment. The majority of the respondents thought that health insurance is a viable programme. 

Conclusion:The perception of health insurance among civil servants was varied while participation was high. Relevant intervention should be introduced to remove bottlenecks to accessing and operating the scheme.

Keywords: National Health Insurance Scheme, Perception of health insurance, Civil servants.

Introduction

The wealth of any country depends on the health of its citizens. Therefore, any country seeking to develop its economy should strive to improve the health of its citizens so they can contribute to economic development.¹ Health, as a social service, is very important to the teeming population of any country as the health sector in any country has been recognized as the primary engine of growth and development.

However, health care in Nigeria is financed by a combination of tax revenue, out-of-pocket payments, donor funding, and health insurance.² Nigeria’s health expenditure is relatively low, even when compared with other African countries^.2 The total health expenditure (THE) as a percentage of the gross domestic product (GDP) from 1998 to 2000 was less than 5%, falling behind THE/GDP ratio in other developing countries such as Kenya (5.3%), Zambia (6.2%), Tanzania (6.8%), Malawi (7.27%) and South Africa (7.5%).^3. Limited institutional capacity, corruption, unstable economy, and lack of political will have been identified as factors why some financing mechanisms of financing health care have not worked effectively.⁴

Further, insurance is a risk transfer mechanism in which the insured makes small periodic payments called premiums to another (the insurer), in return for the payment of benefit packages on the occurrence of a specified event.⁵ Therefore, health insurance involves the pooling of health risks and funds. The National Health Insurance Scheme (NHIS) in Nigeria was designed to provide minimum economic security to workers with regards to unfavourable losses resulting from accidental injury, sickness, old age, unemployment, etc. It is based on a pre-payment system where both the employer and employee make contributions to the scheme and the employee accesses the scheme whenever he/she is ill.⁵ The scheme was officially launched on June 6, 2005, and services to enrolees started later in 2005. According to Osae-Brown, 2013,⁶ over four million identity cards have been issued, 62 HMOs (Health Maintenance Organisations) have been accredited and registered and more applications are being processed. The NHIS is unarguably an indispensable strategy for improving the poor health indices of the country and reducing out-of-pocket expenditure for quality health care services. Since the implementation of NHIS, about five million Nigerians can readily access care through the NHIS.6 The NHIS benefits packages are very comprehensive, covering virtually all the medical needs of the enrollees from consultation, to drugs, consumables, and other minor surgeries.

Undoubtedly, civil servants play a very significant role in the economic development of the country. In desiring a better public service workforce and an effective and efficient delivery of public services, the provision of good, quality healthcare should be considered a top priority to civil servants.16 The NHIS would be of great importance to civil servants because it has attractive packages. Some of its packages include out-patient care, medical consumables, drugs, and diagnostic tests. Free in-patient care in a standard ward for fifteen cumulative days per year is also inclusive.

However, in Nigeria, there is inadequate knowledge, awareness, and capacity regarding an insurance-based health system.^7,43-44 The level of corruption, lack of transparency, and accountability in the country are still very high which has negatively impacted the effectiveness of NHIS.⁷ The provision of quality, accessible and affordable healthcare remains a serious problem. This is because the health sector is continuously faced with a gross shortage of personnel), inadequate and outdated medical equipment,11 poor funding, policies inconsistent health policies,⁸ and corruption.^8-11 Other factors that impede quality healthcare delivery in Nigeria include the inability of the consumer to pay for healthcare services,¹² gender bias due to religious or cultural beliefs,¹³ and inequality in the distribution of healthcare facilities between urban and rural areas.¹⁰ Therefore, this study sought to determine the perception and participation towards NHIS among civil servants working in the federal civil service system at Ibadan.