Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis

Background

Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia.

Methods

Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI.

Results

Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it.

Conclusion

The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

Community perceptions, beliefs and factors determining family planning uptake among men and women in Ekiti State, Nigeria: finding from a descriptive exploratory study

OBJECTIVES

To examine family planning through the community's perception, belief system and cultural impact; in addition to identifying the determining factors for family planning uptake.

DESIGN

A descriptive exploratory study.

SETTING

Three communities were selected from three local government areas, each in the three senatorial districts in Ekiti State.

PARTICIPANTS

The study was conducted among young unmarried women in the reproductive age group who were sexually active as well as married men and women in the reproductive age group who are currently living with their partners and were sexually active.

MAIN OUTCOME MEASURES

Eight focus group discussions were conducted in the community in 2019 with 28 male and 50 female participants. The audio recordings were transcribed, triangulated with notes and analysed using QSR NVivo V.8 software. Community perception, beliefs and perceptions of the utility of family planning, as well as cultural, religious and other factors determining family planning uptake were analysed.

RESULTS

The majority of the participants had the perception that family planning helps married couple only. There were diverse beliefs about family planning and mixed reactions with respect to the impact of culture and religion on family planning uptake. Furthermore, a number of factors were identified in determining family planning uptake-intrapersonal, interpersonal and health system factors.

CONCLUSION

The study concluded that there are varied reactions to family planning uptake due to varied perception, cultural and religious beliefs and determining factors. It was recommended that more targeted male partner engagement in campaign would boost family planning uptake.

Effect of integrated supportive supervision on availability of resources for health care service delivery and uptake of services in Ekiti State, Southwest Nigeria, evidence from the Saving One Million Lives program for result supported facilities

Introduction

a world bank performance-based financing program. The Saving One Million Lives program for results supported integrated supportive supervision (ISS) in selected primary health facilities (PHF) in Ekiti State, Nigeria. The study assessed the impact of ISS on health service outputs and outcomes such as infrastructure, basic equipment, human resources for health (HRH), essential drugs, number of children receiving immunization, number of mothers who gave birth in the facility, number of new and continuing users of modern family planning and the number of pregnant women screened for HIV (human immunodeficiency virus).

Methods

a cross-sectional survey of 70 SOME-supported facilities was used for the study. Parametric and non-parametric method of analysis was employed to compare the mean values of study indicators gathered over the 4 rounds of ISS visits from January 2018 to August 2020.

Results

the study demonstrated that ISS approach has a positive effect on PHC service outputs and outcomes such as infrastructure, basic equipment, health human resources (HRH), essential drugs, contraceptives prevalence rate, skilled birth attendant as well as postnatal care. However, there was no significant impact on HIV screening for pregnant women.

Conclusion

integrated supportive supervision approach has a positive effect on the quality of health care delivery in PHCs in Ekiti State, Nigeria. It is therefore recommended that periodic ISS visits should be routinely carried out in all PHCs across the State in the country and can be further extended to secondary and tertiary facilities.

Trends and Determinants of Non-Utilization of Modern Contraception in Ekiti State, Nigeria: A Ten-Year Review

BACKGROUND

An increase in correct usage of modern contraception is vital in reducing the maternal mortality ratio and Under-5 mortality, leading towards the achievement of Sustainable Development Goal 3. Our study examined the trends and factors affecting non-utilization of modern contraceptives over a 10-year period in Ekiti State, Nigeria.

METHODOLOGY

This study used data from three consecutive National Demographic Health Surveys (NDHS) - 2008, 2013, and 2018 - with a weighted sample size of 1,357 women of reproductive age (15-49 years). Data on contraceptive use on these women, provided by the NDHS, were extracted and analysed using IBM SPSS version 25. The sample was weighted to adjust for disproportionate sampling and non-response. Pearson's chi-square and binary logistic regression were used to assess the factors associated with non-utilization of modern contraceptives.

RESULTS AND FINDINGS

The mean age of the women was 30 years. Modern contraceptive use increased from 13.1% in 2008 to 23.0% in 2018, while unmet need for modern contraceptives decreased from 84.8% in 2008 to 75.4% in 2018. Identified predictors of non-utilization of modern contraceptive were age 20-24 years [aOR=0.33, 95%CI=0.19-0.59], 25-29 years [aOR=0.34, 95%CI=0.18-0.64], 30-34 years [aOR=0.46, 95%CI=0.22-0.94], 35-39 years [aOR=0.29, 95%CI=0.14-0.61] and 40-44 years [aOR=0.37, 95%CI=0.17-0.80] compared to age 15-19 years; living in urban areas [aOR=0.72, 95%CI=0.53-0.98] compared to in rural areas; higher level of education [aOR=0.46, 95%CI=0.21-0.98] compared to no education; and desire for more children [aOR=0.48, 95%CI=0.32-0.73] compared to not wanting more children.

CONCLUSION

Although contraceptive usage increased over time, the factors associated with non-utilization were being an adolescent, living in a rural area, lower level of education, and desire for more children.

Socio-demographic Factors associated with Health-Seeking Behaviour and Clinical Outcomes among Patients attending Health Insurance Facility of a Teaching Hospital in Southwestern Nigeria

BACKGROUND

Inappropriate health-seeking behaviour has been associated with unfavourable health outcomes. This study determined the association between socio-demographic characteristics and health-seeking behaviour and the association between health-seeking behaviour and health outcomes of patients attending the health insurance clinic of a tertiary hospital.

METHODS

The study was carried out between July and November 2021, involving patients who attended the NHIS clinic, of Ekiti State University Teaching Hospital, Ado Ekiti, between 2009 and 2018. The records were reviewed, and data about their socio-demographic characteristics, the period between when symptoms started and the time of presentation in the clinic with the outcome of the patient, were extracted and analysed.

RESULTS

A total of 12,200 patients were seen within the period under review. Females were 51.1%, Yorubas were 92.0%, Christians 95.5%, 51.1% had tertiary education, and 32.5% had primary education. Looking at timely reporting, 58% reported at the clinic 48 hours after symptoms while 23% reported within 24 hours. Of those who presented within 24 hours, 13.1% were admitted compared to 2.2% of those who presented after 48 hours. The association between timeliness of reporting and outcome was statistically significant with p value < 0.05.

CONCLUSION

The severity of the illness determined the timeliness of presentation at the Clinic despite being insured. Social and behavioural change intervention is recommended for attitudinal change to improve health-seeking behaviour.

Comparing the Nigeria National Health Insurance Scheme Act, 2004 and the National Health Insurance Authority Act, 2022 - What is New and its Implications for the Health System

BACKGROUND

Currently, <10% of Nigerians are insured by the National Health Insurance Scheme (NHIS) and this among other things has led to the signing of the National Health Insurance Authority (NHIA) Act in May 2022, which aims at ensuring the effective implementation of a national health insurance policy and attainment of Universal Health Coverage (UHC) in Nigeria.

OBJECTIVE

To highlight the new features of the NHIA Act and its policy implications for the Nigerian health system.

METHODS

A modified Delphi method was used for extracting the differences in the two Acts. A total of three rounds of reviews were carried out among 5 reviewers within three weeks. Differences were tabulated and also presented in prose.

FINDINGS

The NHIA Act makes health insurance mandatory for all residents of Nigeria with the introduction of the vulnerable group fund and implementation of the Basic Health Care Provision Fund through the established State Health Insurance Schemes. Unlike the NHIS which is a Scheme, the NHIA is an Authority and has an expanded function to regulate, promote, manage and integrate all health insurance schemes and practices in Nigeria. Also, funds management has been transferred from Health Maintenance Organizations to the State Health Insurance Schemes and the Health Maintenance Organizations are now excluded from the Governing Council.

CONCLUSION

Certainly, the journey towards UHC could be safer and more equitable with health insurance now mandatory for all Nigerians and the introduction of vulnerable group funds in the new Act. This will eliminate the catastrophic expenses of poor Nigerians if the Act is correctly implemented.

Cost of illness of non-communicable diseases in private and public health facilities in Nigeria: a qualitative and quantitative approach

Introduction

the cost of illness (COI) of non-communicable diseases (NCDs) has detrimental effects on healthcare outcomes in addition to the serious economic impact on patients and their families. This study estimated and compared the COI of NCDs and its predictors in private and public health facilities (HF) in Ado-Ekiti, Nigeria.

Methods

the study was carried out in selected HF (39 private; 11 public) using a comparative cross-sectional design with a mixed method of data collection. Quantitative data were collected from 348 hypertensive and/or diabetic patients (173 private; 175 public) using a semi-structured, interviewer-administered questionnaire while qualitative data were from 5 key informant interviews (KII) conducted with HF heads or their representatives.

Results

the average monthly COI of NCDs was higher among patients in private (₦15,750.38±14,286.47 [US$43.75±39.68]) than in public HF (₦13,283.37±16,432.68 [US$ 36.90±45.65]) (P<0.001), however, the indirect cost was higher in public HF (private, ₦1,561.07 [US$4.34]; public, ₦3,739.26 [US$10.39]) (p<0.001). Predictors of COI of NCDs identified were income and admission in both groups. Additionally, age, payment method, type of NCDs, having two or more complications, and exercise were identified in private while socioeconomic status, length of diagnosis, and alcohol were identified in public HF. The KII revealed a long waiting time for the public HF patients which accounted for the huge indirect cost.

Conclusion

the study found a huge indirect cost in the public HF that could be minimized by developing policies that would reduce the waiting time of patients. Government and private interventions targeting identified predictors should be applied to reduce the financial burden of NCD.

Hypertension and its correlates among in‑school adolescents in Ekiti State, South‑west, Nigeria

Background: Hypertension is one of the major risk factors for cardiovascular disease (CVD). Though generally believed to be a disease of the adults, It has been shown to start in early life and tracks through adolescence into adulthood.Aims and Objectives: The objective of this study was to determine the prevalence of hypertension and associated factors among adolescents in Ekiti State.Materials and Methods: The study was a cross sectional survey involving 416 secondary school adolescents aged 10 to 19 years. A ‘two-stage’ sampling technique was used to select the subjects. Facilitated self-administered questionnaire was used for the study. Data was analyzed using SPSS version 20. Level of significance was set at P<0.05.Results: A total of 416 students participated in the study. Prevalence of hypertension was 10.1% with male and female prevalence rates of 5.8% and 14.4% respectively (P=0.004). Hypertension was higher among adolescents with BMI ≥ the 85th percentile for age and sex compared to those with lower BMI (P=0.004). There was a weak positive correlation between BMI and blood pressure in the study (Systolic r=0.33, P=0.001: diastolic r=0.31, P=0.001).Conclusion: The study concluded that hypertension is not a rare phenomenon among adolescents and that female gender and high BMI were the main risk factors for adolescent hypertension in this study.Asian Journal of Medical Sciences Vol.8(4) 2017 1-5

Knowledge and use of emergency contraception among students of public secondary schools in Ilorin, Nigeria

INTRODUCTION

Unintended pregnancy and unsafe abortion pose a major reproductive health challenge to adolescents. Emergency contraception is safe and effective in preventing unplanned pregnancy. The objective of this study was to assess the student's knowledge and use of emergency contraception.

METHODS

This cross-sectional study was carried out in Ilorin, Nigeria, using multi-stage sampling method. Data was collected using pre-tested semi-structured self-administered questionnaire. Knowledge was scored and analysed. SPSS version 21.0 was used for data analysis. A p-value <0.05 was considered statistically significant.

RESULTS

27.8% of the respondents had good knowledge of emergency contraception. Majority of respondents (87.2%) had never used emergency contraception. Majority of those who had ever used emergency contraception (85.7%) used it incorrectly, using it more than 72 hours after sexual intercourse (p=0.928).

CONCLUSION

Knowledge about Emergency contraception and prevalence of use were low. Contraceptive education should be introduced early in the school curriculum for adolescents.