ASSESSMENT OF AWARENESS AND UTILIZATION OF SOCIAL

HEALTH INSURANCE PROGRAM IN COMPREHENSIVE HEALTH

CENTRE

BY

HAMIDA ADAM
DFSHTS/HIM/115

FEBRUARY, 2024.

INTRODUCTION
1.1 Background of the Study
Health insurance is one of the ways that people in various countries pay for the coverage against
the risk of incurring medical and related financial costs for their medical needs. In every country,
there are people who are unable to pay directly or out of pocket for the healthcare services they
need, or financially they may be seriously disadvantaged by doing so. In lower-income countries,
many forms of health insurance (that is, whether public or private) cover only a minimum set of
services, such that they do not provide full financial risk protection (Anita, 2016). The World
Health Organization (WHO) estimates that out-of-pocket expenditure of over 15–20 % of total
health expenditure or 40 % of household net income of subsistence needs can lead to financial
catastrophe (Doetinchem et al. 2010). When people on low incomes with no financial risk
protection fall ill, they face a dilemma: they can use health services (if available) and suffer
further impoverishment in paying for them, or they can forego services, remain ill, and risk being
unable to work or function. The history of health insurance has evolved internationally. One of the
first countries which institute the Social Health Insurance (SHI) nationally was Germany in 1883
(WHO, 2020). Since then the concept is SHI spread throughout the World. Currently according to
world bank, the system is practiced in more than 60 countries of the world (world Bank, 2021).
Many European states have long embark on health care reforms by introducing still for increased
efficiency and consumer satisfaction in provision of health care services (Steven, 2021).
Delivery of medical care, particularly in industrialized countries, is no longer confined to the
offices of primary care physicians. As medical technologies become increasingly advanced, acute
and critical care can now treat many catastrophic, complex, chronic, and serious conditions and
injuries that used to be fatal or disabling. While the development of new treatments that can
restore functioning and/or extend life is welcoming, the costs of these interventions and
accompanying hospital stays can be prohibitively high for many people. The WHO (2013),
estimates that 150 million people worldwide suffer financial catastrophe each year because of out-
of-pocket expenses for their healthcare needs. Different countries have been utilizing various
models of insurance and financing schemes to pay for medical services based on their respective
socioeconomic realities and cultural contexts. These insurance plans, whether public or private,
have different components and payment requirements depending on the nature of the insurance
plan and the services being covered. Some insurance plans require members to pay premium costs
for enrolling in the program and have various levels of out-of-pocket payments such as
deductibles, co-payments, or coinsurance. They may also require prior authorization from
insurance companies to activate coverage for certain procedures or may impose coverage limits
for enrollees. Some insurance companies may also utilize payment capitation for healthcare
providers to control costs by motivating providers to provide only needed services and in the
lowest cost setting. In general, there are three salient categories of health insurance: National or
social Health insurance (NHI/SHI), Voluntary and Private Health Insurance (PHI) and
Community-Based Health Insurance (CBHI). Nonetheless, variations abound for each category,
and some countries with diverse populations across vast geographical areas (e.g., China) have
multiple insurance programs even for basic healthcare.
Nigeria is among the highest out-of-pocket health spending countries and poorest health
indicators in the world (Gustafsson-Wright and Schellekens, 2013). Out-of-pocket health
expenses play a major role in health financing in Nigeria which does not promote equitable access
to quality health care thus the need for financial risk protection from ill health (Adewale, et al.,
2016). In recognition of this, the federal government introduced the National Health Insurance
Scheme (NHIS) to salvage the health situation and ensure equitable access to health care to all
citizens.
The National Health Insurance Scheme is a social security system that guarantees the provision of
needed quality and effective health care services to enrollees on the payment of token
contributions at a regular interval. It was established under Act 35 of 1999 with the aim of
improving access to health care and reducing the financial burden of out-of-pocket payment for
health care services and officially launched in 2005. It is based on a prepayment system where
both the employer and employee make contributions to the scheme and the employee accesses the
scheme whenever he or she is ill. Primarily, NHIS is to facilitates fair-financing of healthcare
costs through pooling and judicious utilization of financial resources to provide financial risk
protections and cost-burden sharing for people, through various prepayment programmes/products
prior to their falling ill (NHIS, ,2012; Osuchukwu, et al., 2013).
1.2 Statement of the Research Problem
Various studies have been conducted on awareness, perception, knowledge and satisfaction with
the NHIS Scheme among many different professionals. These studies include those by Katibi,
Akande and Akande (2003) on the awareness and attitude of medical practitioners on NHIS in
Ilorin, which revealed that, even though all the respondents were aware of the Scheme, only few
considered themselves as having adequate information on it. Akinwale, Shonuga and Olusanya’s
(2010) investigation on Artisans’ reactions to National Health Insurance Scheme in Lagos State,
shows that only a few artisans expressed knowledge of the NHIS, while majority had zero
awareness of it. Okaro, Ohagwu and Njoku’s (2010) assessment of knowledge and attitude
towards NHIS, showed that all the radiographers were aware of the existence of NHIS with most
reporting source of their information as seminars, newspapers, radio and television. Similarly, in
their study on knowledge and attitude of civil servants in Osun state, Olugbenga-Bello and
Adebimpe (2010), reported that, television and billboards were the main sources of awareness on
NHIS. On the knowledge of the scheme, Adeniyi & Onajole (2010), in their assessment of
knowledge and perceptions of Nigerian Dentists to the NHIS, reported that majority of the
respondents had a fair knowledge of the NHIS and viewed it as a good idea that will succeed if
properly implemented. By contrast, Sanusi and Awe (2009) reported that majority of their
respondents who had assessed the program wanted it discontinued.
The utilization of the National health insurance service is a function of some predisposing factors
among which include awareness of NHIS activities. In addition to the above, many studies have
also shown that knowledge about the activities of the insurance scheme is low in most states in
Nigeria. The study of Adibe, Udeogaranya and Ubaka (2015), revealed that employees of the
University of Nigeria Nsukka have marginal knowledge of the national health insurance scheme
activities. Akintaro and Adewoyin (2015) study on the awareness and attitude towards NHIS in
the Nigerian research institute found that although staff are aware of the health insurance scheme,
the level of awareness of its activities is low. Olayemi (2017) study found that people lack
awareness of the general aspects of the scheme. This study assessed awareness and utilization of
the national health insurance scheme activities of the (NHIS) Comprehensive Primary Health
Care, Lere Local Government Area of Kaduna State, Nigeria.
1.3 Justification of the Studies
Knowledge about an issue will motivate its utilization and the users are most likely to have
positive attitude and good perception towards it (Ilochonwu and Adedigba, 2017). National
Health Insurance Scheme (NHIS) as a financing option can assist in the attainment of universal
health care if it is well-planned and managed properly. However, inadequate budgetary allocations
for health and inadequate mechanism of pooling financial resources and purchasing health
services makes it difficult to effectively increase resources for the health sector either through
taxes, insurance or both (Eneji, et al., 2013). These make the attainment of universal health
coverage a challenge to the health sector in Nigeria; hence the need to conduct a study on
increasing Awareness and utilisation of the NHIS.
National Health Insurance Scheme (NHIS) through its revenue generation, risk pooling,
purchasing and health care provision function can go a long way in unifying health care sector at
least in Lere LGA and the country at large. Revenue generation entails mobilization of funds to
finance health services provision in an equitable and efficient manner (Preker and Carrie, 2004).
This done through payroll deduction from employees' wages and taxes paid from employers. nhis
also helps in risk pooling, which is the aggregation of individual’s health risk in order to minimize
the effects of health care cost on a single individual (WHO, 2000). It also helps in using pooled
funds by an insurance scheme to buy health care services for insured members (Luzon, 2000).
1.4 Objectives of the Studies
The general objective of this study is determine the level of awareness and utilization of social
health health insurance programme in Comprehensive Health Care (CHC), saminaka Lere Local
Government Area of Kaduna State.
The specific objectives are: -
1. To determine the level of awareness of National Health Insurance Scheme (NHIS) among
health workers and patients in CHC, Saminaka LGA.
2. To determine the source/channel which they become aware of National Health Insurance
Scheme (NHIS).
3. To determine the level of utilization of NHIS programme in CHC, saminaka LGA.
1.5 Research Questions
1. What are the level of awareness of National Health Insurance Scheme in CHC, saminaka,
Lere LGA.
2. What are the source/Channel through the people becomes aware of the National Health
Insurance Scheme (NHIS).
3.what are the level of Utilization of National Health Insurance Scheme (NHIS) in CHC,
Saminaka, lere LGA.
1.6 Scope and Limitations
The research would focus on the assessments of the awareness and utilization of National Health
Insurance Scheme (NHIS) in Comprehensive Health Care (CHC) center in Saminaka, Lere LGA
of KADUNA State. That is, it would look into the level of awareness of staff and patients visiting
the health center on what NHIS entails. More so, it would be look at the level of utilization of the
NHIS, through what means and channel do the participants (staff and patients) came to know
about what NHIS is, it's benefits and how it helps in reducing the burden of health care
expenditure.
As for the limitations, the would like to take a wholistic study of all the patients in visiting the
health care center from the locality, but that would be difficult since not all the patients in the
locality that would visit the center during the research data collection period. Also, must of the
patients that are not civil servants would hardly visit the center regular. This condition can force
the researcher to depend on only secondary data from the registry. In addition, due to inadequate
financial resources and cost of transportation, the research would not be able to be undertaken for
a longer period that would enable optimum data to be captured. The time allocation for the
research is also a big limitation.
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