Factors Influencing Satisfaction with Service Delivery Among National Health Insurance Scheme Enrollees in Ibadan, Southwest Nigeria

Perceived quality of care is a determinant of uptake of health services. This study aimed to assess the determinants of quality of care of enrollees in the National Health Insurance Scheme (NHIS) in Nigeria. The outcome was satisfaction with health care services, which was used as a proxy for quality. Findings will assist in the intervention to enhance enrollment in the scheme and for universal health coverage attainment. This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in Ibadan, Nigeria. Data on satisfaction with health care were collected among selected 432 enrollees with the aid of an adapted semi-structured WHO-USAID interviewer-administered questionnaire. Data were analyzed using chi-square and multiple logistic regression models (α = 0.05). Among predictors of satisfaction with health services were younger age (OR = 1.85, 95% CI = 1.05–3.25, p = .024), working in the private sector (OR = 1.84, 95% CI = 1.03–3.28, p = .022), and seeking information about quality of services prior enrollment (OR = 1.63, 95% CI = 1.04−2.53, p = .013). Targeted intervention based on the findings of this study should be implemented to improve satisfaction with the services offered.

The Role of Trust in the Pattern of Enrolment to a Social Health Insurance Scheme and Distribution of Healthcare Facilities in Ibadan, Southwest, Nigeria

The National Health Insurance Scheme (NHIS) of Nigeria established in the year 2005 aims to minimize the inequity of access to quality healthcare services in Nigeria. As of the year 2017, enrolment in NHIS-accredited facilities in the southwest region of Nigeria was significantly clustered, with more than three-quarters of NHIS enrollees registered with only 10% of the available NHIS-accredited facilities in the six states of the region. This study explored the factors associated with the skewed distribution of enrollees across facilities and the influence of stakeholders. This is a descriptive, qualitative, case study design among stakeholders of the NHIS in Ibadan, Oyo State, Southwest, Nigeria. In-depth interviews were conducted between March and June, 2019, with all selected individual stakeholders as listed earlier. Data analysis was done using an inductive thematic approach. Across the board, there was a low level of trust in government and government policies among healthcare providers and enrollees. Few healthcare providers were willing to render services under the scheme at inception. The majority of the enrollees were compelled to register with the few available healthcare providers. Among the enrollees, a few personally chose healthcare facilities and providers that were perceived to render better quality services to receive care. Priority should be given to building trust among stakeholders in the NHIS as this would facilitate cooperation and better working relationship, and reposition the scheme for better performance.

General and tuberculosis-specific service readiness in two states in Nigeria

Background

Tuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria.

Methods

This was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary, and tertiary healthcare facilities in two TB high burden states. Data were collected using key informant interviews, a semi-structured instrument adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions.

Results

The domain score for basic amenities in both states was 48.8%; 47.0% in Anambra and 50.8% in Oyo state with 95% confidence interval [− 15.29, 7.56]. In Oyo, only half of the facilities (50%) had access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states was 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (p = 0.56). The domain score for availability of staff and TB guidelines was 57.1% for both states with 95% confidence interval [− 13.8, 14.4]. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) of the facilities experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states was 75%; this was higher in Oyo (76.5%) than Anambra state (73.6%) (p = 0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing, and gaps with continuing education on TB management.

Conclusions

The weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.

Enrollees' Knowledge and Satisfaction with National Health Insurance Scheme Service Delivery in a Tertiary Hospital, South West Nigeria

Background

Social health insurance scheme provides a platform for mobilizing revenue for health and enhances universal health-care coverage. In addition, knowledge about patients' satisfaction with health care under the scheme will help in identifying gaps and provides evidence toward strengthening the scheme. This study assessed enrollees' knowledge about the National Health Insurance Scheme (NHIS) and satisfaction with health services provided under the scheme.

Materials and Methods

The study was a descriptive cross-sectional survey conducted among the NHIS enrollees accessing health-care services in the University College Hospital, Ibadan. A total of 373 individuals were consecutively recruited for the study, and a semi-structured, pretested interviewer-administered questionnaire was used to obtain information from respondents. Descriptive statistics was used to present results, and Chi-square test was used to test for the association between categorical variables. The level of significance was set at P < 005.

Results

The mean age was 42.5 ± 10.0 years. Of the respondents, 209 (56.0%) were male and 359 (96.2%) were married. About two-thirds, 227 (60.9%), had good knowledge about the NHIS. Majority of the respondents 303 (81.2%) reported paying for some of the costs of service (drugs, laboratory tests, consultation fees, and X-ray) through out-of-pocket and of these, 218 (71.9%) reported that such payments were occasional. Overall, slightly more than half, 197 (52.8%), of the respondents were satisfied with service delivery under the scheme. Female respondents were significantly more satisfied with health-care services (χ² = 3.894,P = 0.048).

Conclusion

There was good knowledge of NHIS, but the level of satisfaction with service delivery was not outstandingly appreciable. There is an urgent need to improve on all areas of quality of service to improve satisfaction with care among enrollees in the scheme.

Understanding the concept of health insurance: An innovative social marketing tool

Health insurance scheme is relatively new in many low to middle income countries. Awareness about and knowledge of the scheme is poor among potential beneficiaries. There are some misconceptions associated with health insurance, which contributes to its low acceptance in affected nations. The aim of this work is to present an information-education and communication concept that will serve as a social marketing tool that could enhance peoples' understanding of the modus operandi of health insurance scheme, and as well as to demystify superstitious belief associated with it. This will contribute to a better understanding of the scheme among the people and enhance its uptake.

Stigmatising Attitudes Towards Co-workers with HIV in the Workplace of a Metropolitan State, Southwestern Nigeria

BACKGROUND

Despite demonstrating global concerns about infection in the workplace, very little research has explored how co-workers react to those living with HIV in the workplace in sub-Saharan Africa. This study aimed to assess the level of stigmatising attitude towards co-workers living with HIV in the workplace.

METHODS

The study was a descriptive cross-sectional survey involving 403 respondents. They were recruited from selected companies through a multistage sampling technique. Survey was carried out using pre-tested semi-structured questionnaires. Data were analyzed using the Statistical Package for the Social Sciences to generate frequencies, cross tabulations of variables at 5% level of significance. Logistic regression model was used to determine the predictors at 95% confidence intervals.

RESULTS

Mean age of respondents was 32.9 ± 9.4 years with 86.1% being females. Overall, slightly below two-third (63.0%) had good knowledge on transmission of HIV/AIDS while 218 (54.1%) respondents had a high stigmatising attitude towards co-workers with HIV in the workplace. More female respondents (69.6%) demonstrated high stigmatising attitudes towards co-workers with HIV in the workplace (p = 0.012). Female workers were twice more likely to have high stigmatising attitudes towards co-worker with HIV [OR 2.1 (95% CI: 1.13 - 3.83)].

CONCLUSION

Stigma towards people living with HIV/AIDs is still very persistent in different settings. Good knowledge amongst our participants about HIV/AIDs did not translate to low stigmatising attitudes among workers. Concerted efforts and trainings on the transmission of HIV/AIDs are essential to reduce stigma that is still very prevalent in workplace settings.

Expanding health insurance scheme in the informal sector in Nigeria: awareness as a potential demand-side tool

Introduction

The implementation and expansion of a health insurance scheme in the informal sector, particularly in developing countries, is a challenge. With the aid of an innovative Information-Education and Communication model, titled 'Understanding the concept of health insurance: An innovative social marketing tool', an assessment of the awareness and perception of the scheme among market women was carried out.

Methods

This is a cross-sectional descriptive survey, carried out among market women in Ibadan, Nigeria. In a multi-stage sampling technique, a total of 351 women were interviewed using an interviewer-administered, semi-structured questionnaire. The data was analysed using SPSS version 16. Chi-square test was used to test associations between selected variables of interest. Logistic regression model was used to determine predictors of awareness of the National Health Insurance Scheme (NHIS). A model controlling for participants' enrolment status was built and Adjusted Odds Ratio (AOR) reported. Level of statistical significance was set at p < 0.05.

Results

A total of 344 market women aged 18 years and above participated in the study, a response rate of 98.0%. Respondents' educational status was the only predictor significantly associated with awareness of the NHIS. Respondents with post-primary education had 10 times the odds of being aware of the NHIS than respondents with no education or only primary education (Adjusted Odds Ratio = 10.3; 95% CI = 4.1-26.0).

Conclusion

Innovative models to enable potential beneficiaries, especially among the informal sector, to better comprehend and accept the concept of prepayment methods of financing healthcare costs is important in efforts to implement and expand a social health insurance scheme.

Exploring the threshold premium for viable community based health insurance schemes in Nigeria

Background

The national health insurance scheme of Nigeria recently proposed a national premium for community based insurance scheme. This study determined the capacity of households in the rural and urban areas in Nigeria to pay for the premium and different hypothetical health insurance schemes namely national health insurance scheme, national urban health insurance scheme, national rural health insurance scheme and regional health insurance schemes. It determined the likely impact of different premiums on membership across socio-economic status quintiles, and then determined the threshold premium affordable to rural and urban households.

Results

The results show that the mean capacity to pay for the households in different regions ranged from US$194 ± 100 to US$986 ± 907. The threshold premiums of the national health insurance scheme, urban national health insurance and rural health insurance schemes were US$66, US$154 and US$53 respectively.

Conclusions

Overall, the threshold premium for rural national health insurance scheme and national health insurance schemes were affordable to the lowest socio economic group. Hence, it is recommended that threshold premium for rural national health insurance scheme be adopted as the maximum premium not to be exceeded in the proposed national health insurance scheme.

The impact of political institution and structure on health policy making and implementation: Nigeria as a case study

BACKGROUND

Typical of the political structure of the United States of America, Nigeria operates a federal presidential system of government. Political power is shared between the three levels of Federal, State and the Local Governments. The political affairs of the country at these levels are determined by elected politicians from different political parties, with different political and developmental ideologies. This scenario has implications on policy making and implementation especially in the health sector. This paper sought to discuss the type of political structures and institutions and, the effect of these on health policy implementation in selected countries, with emphasis on Nigeria. CURRENT STATUS OF FINANCING HEALTH CARE: The National Health Insurance Scheme (NHIS) was launched almost a decade ago but currently covers an estimated four percent of the population, majority of which are in the formal sector. The poor coverage of the scheme in Nigeria has been attributed to the type of political institution and structure it operates. This is evident with examples of some countries in the world; whereas, the scheme in Nigeria was implemented almost at the same time like in neighbouring Ghana, the scheme in Ghana has made a considerable progress. Likewise, prepayment scheme for health in Britain has been in practice for decades, the U.S.A. is just currently making progress in the implementation of a nationwide prepayment scheme despite several years of efforts. It is important to note that Nigeria and the U.S.A. has similar political institution and structure different from what Ghana and Britain have in common.

CONCLUSION

The current low level of coverage of the NHIS in Nigeria is largely due to the type of adopted political institution and structure. The implications of this on the health status of the people and national development cannot be overemphasized.

Predictors of maternal HIV infection at the primary care level in inner city Ibadan

National HIV prevalence rate is derived from the sentinel surveys, which are carried out once in two years and remain anonymized. Epidemiological data are largely unavailable on the pregnant HIV-positive mothers particularly at the grass root level. This information is urgently needed when developing a realistic intervention programme. Three hundred and forty-three consenting pregnant women attending a randomly selected primary health care clinic in inner city Ibadan from April to November 2001 were enrolled at booking and followed up till delivery of their babies. Sociodemographic and reproductive health data were collected by questionnaire and all mothers were screened for HIV/AIDS using an enzyme-linked immunosorbent assay based rapid test. Results showed that about one in three teenage mothers screened positive, having the highest HIV rate. HIV prevalence rate reduced, though not significantly, in mothers 20-29 years and those 30-39 years with mothers in these groups having similar rates. No mother over 39 years screened positive. Following logistic regression analysis, young age 15-19 years, was associated with a significantly increased risk for infection at the primary health care level (P =0.046). Christian religion was associated with a lower risk (P =0.038), and mothers who booked late in pregnancy (P =0.025) or had husbands in the lower socio-economic class (P =0.001) were less likely to be infected. None of the women were aware of their HIV status prior to the study. With a predominantly heterosexual mode of HIV transmission, it is necessary to identify infected pregnant women early through voluntary counselling and testing (VCT), so that they can be given the option to take preventive drugs, which would among other benefits reduce mother-to-child transmission, and help infected mothers stay healthy and productive for longer.

Characteristics of volunteers and non-volunteers for voluntary counseling and HIV testing among unmarried male undergraduates

The 2001 HIV sero-prevalence survey in Nigeria revealed a rate of 5.8 percent with those under the age of 25 years having the highest prevalence rate. Most University students fall within this age group. This study is part of a larger study on the sexual behavior of youths and young adults and was designed to compare the characteristics of volunteers and non-volunteers for voluntary confidential counseling and HIV testing (VCT) among males. Six hundred and nine male undergraduate students were randomly selected and enrolled for the study. Data were collected using a pre-tested questionnaire. Of the 609, 51 (8.3%) volunteered to have their blood screened for HIV. All volunteers who received pre-test counseling went for the HIV test. Volunteers were significantly older than the non-volunteers (P<0.0001), and were more likely to be sexually experienced (P=0.002). Among the sexually experienced, the volunteers were older at first sexual intercourse (FSI) (P<0.0001), and were more likely to have used a condom at FSI (P=0.001). Volunteers had significantly higher knowledge scores for HIV/AIDS (P=0.006), and the attitude to HIV/AIDS in both groups was positive. The marriage pattern of their parents with regard to polygyny was similar, and fewer volunteers had fathers in the higher socio-economic class and mothers who had completed secondary education (P<0.00001, (P=0.02). Among the 51 volunteers, 8 (15.7%) tested positive. Those who tested positive were less likely to have lived with parents, and were all sexually experienced. Those who screened positive were also more likely to be currently sexually active and to have fathers with low level of education. Three (5.9%) of volunteers did not return for results and posttest counseling. One of the three was positive for HIV. Of those who tested positive, 3 (37.5%) reported not using the condom at all, while the rest were using it only occasionally. VCT among the youths is possible however, small numbers encountered in the study is a limitation and there is a need to replicate this study using larger numbers. Tertiary institutions should provide VCT services for the students where they can be counseled appropriately and continuously throughout their stay in the institution. This hopefully will reduce the number of new HIV cases seen.