THE NIGERIA HEALTH INSURANCE SCHEME: CHALLENGES AND PROSPECTS

TABLE OF CONTENTS

Cover page        –       –       –       –       –       –       –       –       –       i

Title page  –       –       –       –       –       –       –       –       –       ii

Certification –      –       –       –       –       –       –       –       –       iii

Dedication –       –       –       –       –       –       –       –       –       iv

Acknowledgement      –       –       –       –       –       –       –       v

Abstract     –       –       –       –       –       –       –       –       –       vi

Table of content —      –       –       –       –       –       –       –       viii

CHAPTER ONE

1.0   INTRODUCTION

1.1    Background of the study     –       –       –       –       –       1     

1.2    Statement of the problems   –       –       –       –       –       3

1.3    Objectives of the study        –       –       –       –       –       –       8     

1.4    Significance of the study     –       –       –       –       –       8

1.5    Research questions     –       –       –       –       –       –       9     

1.6    Research Hypothesis   –       –       –       –       –       –       9     

1.7    Scope of the study      –       –       –       –       –       –       10

1.8    Limitations of the study       –       –       –       –       –       10

1.9    Definition of term        –       –       –       –       –       –       11

CHAPTER TWO

2.0   REVIEW OF RELEVANT LITERATURE

2.1    An Overview of health service delivery in Nigeria    –       13    

2.2    Objectives of National Healthcare  –       –       –       –       16

2.3    Imperatives of free healthcare delivery  –       –       –       17

2.4    Financing of healthcare services in Nigeria     –       –       19    

2.5    The National Health Insurance Scheme –       –       –       24

2.6    The National Health Insurance Scheme Programme        –       27

2.7    Excluded services       –       –       –       –       –       –       30

2.8    Management of the national healthcare insurance scheme 30

2.9    Benefits of the national health insurance scheme    –       39

2.10  Number of HMO currently registered with NHIS     –       45

CHAPTER THREE

3.0   RESEARCH METHODOLOGY

3.1    Research design –       –       –       –       –       –       –       57

3.2    Sources of data  –       –       –       –       –       –       –       57

3.3    Population of the study       –       –       –       –       –       –       58

3.4    Determination of sample size        –       –       –       –       –       58

3.5    Method of data analysis       –       –       –       —      –       59

3.6    Decision Criteria for validation      –       –       –       –       59

CHAPTER FOUR

4.0   DATA PRESENTATION AND ANALYSIS

4.1    Data Presentation and Analysis    –       –       –       –       60

4.2    Test of Hypothesis      –       –       –       –       –       –       71

CHAPTER FIVE

5.0   SUMARY, CONCLUSION AND RECOMMENDATIONS

5.1    Summary of findings   –       –       –       –       –       –       78

5.2    Conclusion –       –       –       –       –       –       –       –       80

5.3    Recommendations      –       –       –       –       –       –       81    

        Bibliography       –       –       –       –       –       –       –       84

        Questionnaire     –       –       –       –       –       –       –       88

CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF THE STUDY

A popular adage says that a healthy person is a wealthy person. Mfon (2005:21) expresses that a nation with an effective healthy care system is a wealthy nation and is development oriented in the social context. One of the basic needs of the people of any nation is good health. This incorporates physical fitness, adequate nutrition and food security, high life expectancy, absence of adequate and endemic disease and efficient health care service delivery. In Nigeria, however, the healthy situation is a manifestation of malnutrition, low life expectancy of the majority, high incidence of epidemic and endemic disease as well as inefficiency healthcare service delivery.

It has been emphasis that no meaningful development can take place in the country if the greater proportion of the population have no access to effective health care services and live in squat or and disease.

According to Omoruan, Bemidelle & Philips (2009:2) every government in Nigeria holds the view that a healthy population is essential for rapid socio-economic development of the country hence healthcare is on the concurrent list in the Nigerian constitution and its allocation comes next to education and defense in the national budget. Despite the large population, social services including health car services are inadequate coupled with several challenges facing the system. Various reforms programmes have been put forward and government has expressed it determination to pursue a bold reform of the system.

Thus, in May 1999 the government created the National Health Insurance Scheme (NHIS) by enacting into law Decree No. 35 on 10^th May 1999, (now Act 35 of 1999) the scheme encompasses government employee, the organized private sector and the informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates.

Thus, when Obasanjo administration came into being on May, 29 1999, the nation’s health sector was near comatose. Hospitals were in bad shape community an inter-sectoral collaboration was minimal (Adiekwe, 2009:2). Ugbaja (2007:19) remarks that resources devoted to this vital social services were insufficient. Worst still, there was out right, inadequacy of drugs and other consumables in most government health facilities. There was also paucity of qualified manpower in the government hospitals. The available motivated while facilities and equipment were poorly maintained.

Other lapses of the past include inadequate manpower development to meet modern trend and improper monitoring of services rendered t the public among others.

The National Health Insurance Scheme initiative was kept alive by Chief Olusegun Obasanjo the successor of Abubakar as a democratic president by further giving more legislative powers to the shame in 2004 with positive amendments to the original 1999 legislation. Implementation was however delayed till June 6^th, 2005 (NHIS, 2005).

STATEMENT OF PROBLEMS

Organizational capacity in the management of an insurance based healthcare service is lacking at all levels of operation – health facilities (providers), Health Maintenance Organizations (HMOs) i.e. third administrators and council of NHIS (regulators). The skill              gap range from basic understanding and application to competencies in day-to-day business operations.

Care Net Nigeria (2011) captured it as follows: