ABSTRACT
National Health Insurance Scheme (NHIS) is a system of healthcare financing introduced by
Federal Government of Nigeria to help reduce the risks and minimize the costs of
healthcare. Since its inception, only the Formal Sector Social Health Insurance Programme
(FSSHIP) has comprehensively taken off. This study investigated the knowledge and
perception of Federal Civil Servants in Abuja Municipal Area Council (AMAC), Federal Capital
Territory (FCT). A sample size of 383 Civil Servants were selected. The instrument for data
collection was a researcher – designed 30 item questionnaire. Data were analysed using
descriptive statistics such as frequencies, percentages, mean and standard deviation.
Hypotheses were tested using inferential statistics such as student’s t-test and Chi-square.
Findings showed that majority of the civil servants (56.3%) had fair knowledge of NHIS
programme. The civil servants had a positive perception of the NHIS programme (Overall
Mean = 2.81). Majority of the respondents (60%) accessed care under the scheme. Findings
from the study also showed that the civil servants who utilized the scheme had a better
perception of the programme (mean = 2.84) when compared to those who didn’t (P =
0.038). Education was significantly associated with knowledge and positive perception of the
programme. There was no association between grade level and knowledge of NHIS
programme. In addition, their perception of the programme was not dependent on their
gender. The study concluded that intensified campaign on the objectives, benefits and
workings of the scheme should be ensured. This should be facilitated by the nurses and use
of mass media in order to reach a vast majority of the workforce and enhance their
perception of the programme.
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CHAPTER ONE
INTRODUCTION
Background to the Study
Health system are designed to improve the standard of health care of the population.
Improved funding and management of health systems lead to social stability.
Population’s coverage is a clear indicator of the performance of the health system.
The policy of National Health Insurance Scheme (NHIS) aims at increasing coverage
of the Nigerian population. Health insurance as a health care financing mechanism
has become a sought-after approach to the problem of financing healthcare all over
the. world. The current concern with financing, and the specific interest in health
insurance is often the result of parallel trend; the recognition of basic healthcare for all
citizens as a fundamental human right on the one hand, and the difficulties faced by
governments in developing and maintaining resources to provide health care through
general taxation revenue on the other (Mgbe & Kelvin, 2014). World Health
Organization (WHO) has been giving tremendous support and cooperation to nations
that pursue their citizen’s welfare through health insurance. They further noted that,
nations equally are channeling large chunk of their budget to the attainment of good
health for their people.
Health insurance can be categorized as social (or government) health insurance and
private health insurance. Where a system is financed by compulsory contributions
mandated by law or taxes and the system provisions as specified by legal status, it is
social (or government) health insurance plan. On the other hand, private health
insurance is usually financed on a group basis but most plans also provide for
individual policies (Adeoye, 2015).
Health Insurance, according to (Adeoye, 2015) is assuming the status of a global
phenomenon. It was first introduced in Germany in 1883 under General Von
Bismark’s old age and disability insurance scheme. Since then, health insurance has
continued to gain prominence in the other industrialized nations like France, United
Kingdom etc. Developing countries too have joined in beaming their health search
light on health insurance. Prominent among them are Costa-Rica, Brazil, Bangladesh,
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China, India, Pakistan, Thailand, etc. In Africa it has been introduced in Tanzania,
Kenya, Ghana, South Africa, Zimbabwe etc (Agada-Amade, 2007).
In Nigeria, the rising cost of medical care, coupled with poor funding of the health
care sector by government, in addition to severe down turn in the Nigerian Economy
in the 1980’s and 1990s resulted in the abysmal patronage of the orthodox medical
and other healthcare or health institutions (Afoloyan-Oloye,2008). Most of these
health institutions either down-sized or closed down completely and their health
practitioner’s brain-drained for greener pasture. Majority of the people according to
Afoloyan-Oloye (2008) resorted to patronizing alternative health care practitioners,
such as the herbalists and the spiritualists. Mortality from common diseases became
the order of the day. This resulted in government implementing various intervention
designs which included the Bamako initiative, user-fee and Drug Revolving Fund.
After several committees and commissions, the Federal Government approved the
National Health Insurance Scheme (NHIS) in 1989 as a viable means of health care
financing for the achievement of easy access to quality health care for the Nigerian
people (Adeoye, 2015). It was formally launched on October 15, 1997 and the decree
was signed into law in May 1999.
National Health Insurance Scheme (NHIS) is a body established under Act 35 of 1999
by the Federal Government of Nigeria to improve the health of all Nigerians at an
affordable cost (Adeoye, 2015). NHIS according to Mgbe & Kevin (2014), is a social
security system adopted by Nigerian Government to guarantee the provision of
needed health services to persons on the payment of token contribution to the
common pool, at regular intervals. In the context of this study, NHIS is a system of
health care financing introduced by Federal Government of Nigeria to address the
problems of health care delivery which has been affected by challenges. It can be seen
as a typical example of Public Private Partnership [PPP] in health care delivery in
Nigeria. Its main goal is to enhance the health status of the citizens through provision
of financial risk protection and customer satisfaction. The hope of the average
Nigerian to have a reliable and affordable healthcare delivery system has been
brightened with the take-off of the long awaited National Health Insurance Scheme
(Mgbe & Kevin, 2014).