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OHALETE CHIGOZIRI AGUNOBI
REG NO: PG/MBA/06/46074
MANAGEMENT OF NATIONAL HEALTH
INSURANCE SCHEME (NHIS) IN NIGERIA,
ISSUES, PROBLEM AND PROSPECTS.
MANAGEMENT
A THESIS SUBMITTED TO THE DEPARTMENT OF MANAGEMENT, FACULTY OF
BUSINESS ADMINISTRATION, UNIVERSITY OF NIGERIA ENUGU CAMPUS
Webmaster
Digitally Signed by Webmaster’s Name
DN : CN = Webmaster’s name O= University of Nigeria, Nsukka
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JULY, 2008
MANAGEMENT OF NATIONAL HEALTH INSURANCE
SCHEME (NHIS) IN NIGERIA, ISSUES, PROBLEM AND
PROSPECTS.
BY
OHALETE CHIGOZIRI AGUNOBI
REG NO: PG/MBA/06/46074
A RESEARCH PROJECT PRESENTED TO THE
DEPARTMENT OF MANAGEMENT FACULTY OF
BUSINESS ADMINISTRATION UNIVERSITY OF
NIGERIA, ENUGU CAMPUS
IN PARTIAL FULFILLMENT OF THE REQUIREMENT
FOR THE AWARD OF MASTERS IN BUSINESS
ADMINISTRATION IN MANAGEMENT
JULY 2008
TITLE PAGE
MANAGEMENT OF NATIONAL HEALTH INSURANCE
SCHEME (NHIS) IN NIGEIRA, ISSUES, PROBLEM AND
PROSPECTS.
BY
OHALETE CHIGOZIRI AGUNOBI
REG NO: PG/MBA/06/46074
A RESEARCH PROJECT PRESENTED TO THE
DEPARTMENT OF MANAGEMENT FACULTY OF
BUSINESS ADMINISTRATION UNIVERSITY OF
NIGERIA, ENUGU CAMPUS
IN PARTIAL FULFILLMENT OF THE REQUIREMENT
FOR THE AWARD OF MASTERS IN BUSINESS
ADMINISTRATION IN MANAGEMENT
JULY 2008
CERTIFICATION
Ohalete Chigoziri .A., a post graduate student in the
department of management with registration number
PG/MBA/06/46074 has satisfactory completed the
requirement of the course and research work for the
award of Masters in Business Administration (MBA).
The work embodied in this report is original and has
not been submitted in part or full for any other diploma or
degree of this or any other University.
………………………………… OHALETE CHIGOZIRI A
PG/MBA/06/46074 ………………………. ………………………. CHIEF J.A. EZEH C.O CHUKWU Supervisor Head of Department
DEDICATION
This work is dedicated to Almighty 'God and to my
lovely wife for her support throughout the duration of this
project work
ACKNOWLEDGEMENT
Most importantly and above all, my utmost honour
and thanks go to the Almighty God, whose divine love,
protection and benevolence saw me through all the days of
my programme and especially to the successful
completion of the course.
I wish to express my in - depth gratitude to my
project supervisor Chief J. A Ezeh for his valuable
suggestions and comment which made this work a
success. Sir, I say thank you.
My greetings will not be complete, if I fail to thank
my beautiful and lovely wife, I met during this programme
for her contribution and support which is enormous
indeed. A million thanks. Darling.
Finally, I acknowledge the love and moral support of
my friends and family.
ABSTRACT
The aim of this study is to find out how the National
Health Insurance Scheme is managed. This is against the
background of the need to highlight its strengths and
identify sources of its shortcomings. Data were then
collected from both primary and secondary sources. The
main instrument used in collecting the data is
questionnaire.
The data were then presented in tables as frequency
distribution. The techniques of frequency and percentage
were applied in analysing the data. The following are the
major findings of the study: The NHIS was introduced
against the background of poor state of the national
healthcare system. The scheme aims at giving all
Nigerians access to good healthcare services, ensure
equitable distribution of healthcare costs and facilities and
high standard of Healthcare services.
The scheme is funded through joint contributions by
government and workers. The NHIS regulates the scheme
while the managers are the HMOS. Clinical and laboratory
services are provided by HSPs.
TABLE OF CONTENTS
Title page
certification
Dedication
Acknowledgment
Abstract
Table of content
List of Tables
CHAPTER ONE: INTRODUCTION
1.1 Background of the study
1.2 Statement of problem
1.3 Objective of the study
1.4 Research Questions
1.5 Formulation of Hypothesis
1.6 Significance of the study
1.7 Scope of the study
1.8 Limitation of the study
1.9 Definition of terms
CHAPTER TWO: LITERATURE REVIEW
2.1 An overview of the Healthcare services Delivery in
Nigeria
2.2 The Goals of National Health Policy
2.3 Imperatives of Improved Healthcare
Services Development
2.4 Financing of Healthcare service in Nigeria
2.5 National Health Insurance Scheme (NHIS)
2.6 National Healthcare Insurance Scheme Programmes
2.7 Healthcare Services of National Health Insurance
Scheme
2.8 Excluded services from the NHIS Scheme
2.9 Management of the National Health Insurance
Scheme
2.9.1 Health Maintenance Organization (HMOS)
2.9.2 Health Services Providers (HSPs)
2.9.3 Health Services Providers (HSPS)
2.9.4 Funding of the Scheme
2.9.5 Operational Procedure and Coverage
2.10 Evaluation of the NHIS
2.11 Problems and prospects of the NIHS
CHAPTER THREE: RESEARCH METHODOLOGY
3.1 Research Design
3.2 Area of study
3.3 Sources of Data
3.4 Population
3.5 Sample size Determination and Sampling Technique
3.6 Instrument
3.7 Data collection procedures
3.8 Data Analysis Techniques
CHAPTER FOUR: DATA PRESENTATION AND
ANALYSIS
4.1 Data Presentation and Analysis
4.2 Test of Hypothesis
CHAPTER FIVE: SUMMARY, CONCLUSION AND
RECOMMENDATION
5.1 Summary of Findings
5.2 Conclusion
5.3 Recommendations
Bibliography
Appendix
LIST OF TABLES
4.1 Administration of questionnaire
4.2 Sex Distribution of Respondents
4.3 Age Distribution of Respondents
4.4 Marital Distribution of Respondents
4.5 Highest Educational Qualification of Respondents
4.6 Organization Distribution of Respondents
4.7 Responses to NHIS fully operational in the public
sector
4.8 Goals of the NHIS
4.9 Responses to NHIS aiming at achieving efficient
Health care Services Delivery
4.10 NHIS Funding Strategy
4.11 Mangers of NHIS
4.12 Roles of NHIC
4.13 Role of HMOS
4.14 Role of HSPS
4.15 Problems of NHIS
4.16 Responses to the scheme having Prospects for
success
CHAPTER ONE
INTRODUCTION
One of the cardinal objectives of good government is
to have effective healthcare delivery system put in place
for the entire citizenry. A healthy nation is a wealthy
nation because of the absence of debilitating diseases and
epidemics in such a country, which, along with hunger
and squalor, impoverishes the citizenry (Nwatu, 2000:12).
Ensuring adequate nutrition, high life expectancy, and
very low incidence of epidemics and diseases has been
acknowledged as most important duty of any government.
Unfortunately, in most developing countries
(including Nigeria) poor state of the nations' healthcare
system reinforces poverty and squalor to further
deteriorate living conditions (Nwosu, 2002:8).
The indispensability of good healthcare system in
national development underlies the governments
commitment to providing adequate healthcare services
since Nigeria attained political independence in 1960
(Ugbaja, 2003:6). in terms of cost and delivery, the
Nigerian healthcare system was adjudged effective and
efficient in the periods of the 1960s and up to the late
1970s, by the early 1980s shortage of health facilities
including drugs and personnel had set in resulting in
rising cost of healthcare services.
The situation seemed to favour private sector health
institutions which were enjoying relative boost in
patronage as the general poor state public healthcare
system continued deteriorating.
According to Abacha (1985:3), the public hospitals
had become (consulting clinics" Given the rapid
population growth rate, what the nation needed was a
commensurate increasing level of are services. But the
decreasing finance of the government oil left the
government with no other choice than reducing budgetary
allocation to the health sector (Ozuh, 2004:30) prior to the
government almost solely financed health services in
public health institutions. But by the turn of the 1980s, it
had become joint responsibility of the government and the
citizens (Ughamadu, 2003:23). In other words both the
government and the citizens shared the costs of
healthcare services in public health institutions with the
greater burden weighing heavily on the government.
Subsidization of healthcare services was paramount in
healthcare budgetary allocation.
As a panecea to the increasing depending on the
government for social services, the international monetary
fund (IMF) packaged some economic reforms among which
was removal of subsides in the oil and health sectors. This
is a precondition for the granting of a $2.5 million loan to
Nigeria. The rejection of the loan led the government to
implement some aspects of the conditionalities including
reduction of healthcare financing (Olaghere, 2000:42).
This was also in response to the call by participants in a
conference organized by the federal government to
deliberate on alternative ways of funding the health sector.
The participants, among other things; called for joint
healthcare services financing (Obadan, 2002:10),
Thus, in line with the public sector reforms, the
health sector reform became paramount with adequate
financing as its cardinal objective. The culminated with
the introduction ^r launching of the National Healthcare
insurance Scheme (NHIS) on June 6, 2005 by the Federal
Government. According to Umar (2005:13) the NHIS
represents a milestone in the quest for adequate financing
of healthcare services in the country.
From both internal and external sources, Nigeria's
health sector expenditure amounted to 1.95% of the GNP
in 2003 or $4.8 per capital External sources financed
50.2% while internal sources accounted for 49.8% Direct
financing method was increasingly advocated for as a
source of additional resources for healthcare services.
The methods includes user - fees and pre-payment
schemes. User- fees and drug sales are the methods most
frequently used because of their greater administrative
simplicity (Oduenyi, 2003:21). Topically, the revenues
generated by user-fees in the public sector are rather
modest, thus, increasing government burden in health
financing. This gives justification for the National Health
Insurance Scheme.
According to Obasanjo(2005:2) the basis for the
establishment of the Nation Health Insurance Scheme
(NHIS) include;
The general poor state of the nation's healthcare
system.
The excessive dependence and pressure on
government
Dwindling funding of healthcare in the face of rising
costs, and
Poor integration of private health facilities in the
nation's
healthcare delivery system.
This study is therefore set to examine the management
of the scheme with a view to determining its benefits,
problems and prospects.
1.2 STATEMENT OF PROBLEM.
Three years after its inception, the NHIS has not
effectively taken off and operated as initially conceived.
This is as a result of challenges facing the scheme. First,
the scheme is still limited to the public sector and has not
been extended to the private sector due to apparent lack of
political will and commitment. The scheme suffers from
restricted coverage.
Second, there is continuous delay in
remittance from government establishment to the NHIS
council,! which also delays remittance to Health
Maintenance Organization (HMOS) Providers (HSPS). This
makes the scheme to suffer from ineffective financing.
Third, the scheme lacks adequate facilities and personnel
to cover the nation sufficiently.
This arises from the limited number of the Health
Maintenance Organization (HMOS) and Health Service
Providers (HSPS) registered to operate in the scheme.
Besides, most of the HSPs lack adequate medical
equipments and dedicated personnel to implement the
scheme.
Fourth, many of the Health Service Providers (HSPs)
are withdrawing from the scheme and some functional
ones are refusing to register new clients or public
servants.
Finally, inadequate logistic support or support
facilities from the government and donor-agencies affects
the scheme adversely. Furthermore, adequate publicity or
enlightenment has not been given to the people on the
scheme.
1.3 OBJECTIVE OF THE STUDY
The objectives of the study are;
1. To examine the rational for the NHIS
2. To examine the goals of the scheme
3. To find out the funding strategies for the scheme
4. To examine the roles of the operators of the scheme.
5. To establish the benefits and problems of the scheme
1.4 RESEARCH QUESTION
The following questions with are addressed;
1. What is the rationale for the NHIS?
2. What are the goals ofthe scheme?
3. What is the funding strategy for the scheme?
4. What are the roles of the operator of the scheme?
5. What are the benefits and problems of the scheme?
1.5 FORMULATIONS OF HYPOTHESES
The following hypotheses are formulated for the study;
1. Ho: The rationale for the NHIS is not general poor
state of the nation's healthcare system.
Hj: The rationale for the NHIS is the general poor, state of
the nation's healthcare system.
2. Ho: The goal of the NHIS is not efficient healthcare
services delivery.
Hj: The goal of the NHIS is not efficient healthcare services
delivery.
3. H0: The problems of the NHIS are not essentially
administrative.
Hj: The problems of the NHIS are not essentially
administrative.
1.6 SIGNIFICANCE OF THE STUDY
The study will be useful to the following;
1. National Health Insurance Scheme Council (NHISC)
This regulatory body of the NHIS will find this study
useful. This is because it will identify all the
constraints to effective implementation of the scheme
especially as it effects HMOs and HSPs. The
regulatory aspect of these challenges will be
established in this study so that the NHISC will take
remedial measures. The recommendation of this
study will be useful in this regard.
2. Health Maintenance Organization (HMOs)
These organizations will also benefit from; this study.
This is because it will not only highlight the
challenges facing them under the scheme but will
also provide useful information on how they can
effectively address these challenges especially those
arising from their internal constituencies.
3. Health Services Providers. (HSPs)
These private health institutions will also benefit
from this study. Those already operating under the
scheme will be provided with useful information on
how to brace up with their challenges while those not
yet operating under the scheme will find in this study
the need to be integrated into the national healthcare
delivery system via the NHIS.
4. The Government
The government will also see the need to solicit for
foreign assistance to effective implementation of the
programme as well as to ensure prompt remittance
to the NHISC and HMOs from its establishments.
The recommendations in this study will also be
useful for its policy review in respect of the scheme.
5. Students
Definitely, the study will add to the little literature on
the NHIS and can also serve as reference material to
those who will carry out related studies in the future.
6. The Society
The study will also be useful to the society at large.
This is because it will give a full exposition to NHIS
and how they can benefit from the scheme.
1.7 SCOPE OF THE STUDY
This study focuses on the rationale, goal,
management, finding, benefits, problems and prospects of
the NHIS.
1.8 LIMITATION OF THE STUDY
The limitations of the study are;
1. Limited information.
The NHIS is relatively new in Nigeria. Consequently,
not much work has been done on it or primary
information for the evaluation of its performance.
2 Inadequate finance
This prevented the researcher from gojng to the
headquarters of NHIS for information.
1.9 DEFINITION OF TERM AND ACRONYMS
1. National health insurance scheme:- This is
a security programme under which employers and
employees finance health services through
contribution (Lambs, 2006:16).
2. Health Service Providers:- This refers to any health
institution (hospital, health centers clinics, etc)
authorized to provide healthcare service under the
NHIS (Ozuh, 2004:30)
3. Health Maintenance organizations (HMOs):- This
refers to any authorized body or organization to
administer the NHIS by liaising between the NHISC
and HSPs (Ozuh, 2004:30).
4. Healthcare Delivery System: - This refers to the
provision of health service to. The people
(Ughanmadu, 2003:23).
5. HMOs an acronym for Health maintenance
organizations (Uduma, 2005:3)
6. HSPs an acronym for Health Service Providers
(Uduma, 2005:3).
REFERENCES
Abacha, S (1985:3) "Why Buhari was sacked" Daily Times
Thurs. August 27.
Nwatu, R (2000:12) "Making the health system Effective"
Medical Journal. Jan.
Nwosu, A.B.C (2002:8) Healthcare Financing in Nigeria;
2000-2003" Medical Journal. Vol. 21 No 3.
Obadan, M (2002:10) "Imperatives of effective Healthcare
system" Healthcare. Aug 23
Oduemyi, B. (2003:21) "Alternative health care
financing" A conference paper.
Olaghere, A (2000:42) "Health financing in Nigeria" Social
Insurance (ed) Lagos: liupeju publishing co.
Ozuh, I (2004:30) "The National Health Insurance Scheme"
Bullion Vol. 23 No 10.
Ugbaja, C.O (2003:26) "Alternative method of Healthcare
financing" Community Medicine. Oct - Dec.
Ughanmadu, C (2003:23) "Health and National
Development" Medical Journal. Vol. 20 No 3.
Umar, A (2006:13) " Improving the health sector through
social insurance. The vanguard. Tue June 10.
CHAPTER TWO
LITERATURE REVIEW
In this chapter, some relevant literature on
healthcare services Delivery and National Health
Insurance Scheme (NHIS) were reviewed. This covered the
following;
2.1 AN OVERVIEW OF HEALTHCARE SERVICES DELIVERY
IN NIGERIA
An important question most health experts have
tired to address in discussing healthcare services delivery
in Nigeria has been: "what really determines the overall
health condition of the Nigerian populace" one obvious
possible answer is health services, and the number of
physicians or hospital beds as well as availability of drugs
and other related factors. According to Soyinka (2000:19)
good health is one of the most important basic needs of
mankind and is indispensable in social and economic
development of a nation.
The Nigerian governments had recognized the need
good healthcare services for the nation and have been
purchasing the objective of adequate healthcare services
delivery since the nation attained political independence in
1960.
Although the nation's health facilities were not
developed as they are today, it is acknowledge that
healthcare services delivery was efficient and effective in
most parts of the country in the 1960s and 1970s.
According to Dimeji (2000:10), it was a period all
levels of government were very much committed to
ensuring adequate health care services even with the
limited health personnel and physical facilities. Health
considerations were taken into account in all development
planning then rather than having health regarded as a
matter of giving money to the Ministry of Health for a new
hospital or adding a clinic to a development project.
A comparative study on healthcare service in Nigeria
for the periods 1960 - 1980 and 1981 - 2000 showed that
there were fever number of medical and health personnel,
hospital and other health facilities in the country in 1960
- 1980 period i.e. fever number of doctors, nurses,
hospital, clinics and community health centers.
Dimeji (2000: 10) remarks that despite the high
doctor - patient and nurse - patient ratios health service
were more effective and effective than what obtained in the
period 1980 - 2000. although there was rapid expansion of
health facilities in the second half of the 1970s due to oil
boom that saw budgetary allocation expanded in the
health sector, the rapidly growing population more than
offset the progress in the second half of the 1980s to the
1990s.
This finding was collaborated by that of the world
Health Organization (2001:42) that showed a marked
deterioration in Nigeria's health care services delivery in
1985 - 1995 relative to 1975 - 84 period. It was found that
over these periods, there had often been much emphasis
on sophisticated and expensive clinical practice in large
urban hospitals.
At the same time, environmental health, water
supply and sanitation had generally received little
emphasis until the 1990s, except to a little extent in a few
major cities.
While this may have corresponded to the realities of
powerful social and political forces - the vested interests of
an urban elite and of the medical profession - such
activities have scarily touched the health problems of he
bulk of the population, who often live in rural areas out of
reach of official personnel services and whose health
situation is hardly affected by episodic curative health
care.
Ramesome Kuti (1992:17) posits that it is this
discouraging healthcare condition that informed the
launching of the Primary Healthcare Services Scheme in
1990. Under this scheme, there was proliferation of public
and private health intuitions and facilities throughout the
country. Since then there is at least one private health
institution in every town and one public health institution
in each local government throughout the country (Mba,
2002:8).
The rapid expansion of private health care
institutions since the mid - 1980s represents a milestone
in the quest for improved healthcare services delivery in
the country. This then called for effective integration of the
private health institutions into the National Health Policy
so as to ensure effective provision of healthcare service
throughout the country.
2.2 THE GOALS OF NATIONAL HEALTH POLICY
The Nigeria government has been pursuing a
national policy on health aimed at ensuring adequate
efficient and effective healthcare services delivery since the
1960s although this quest faced serious 1980s.
In his 1989 budget speech, ex-president
Ibrahim Babangida (1989:12) remarks that;
"Government is, in particular, deeply
concerned about the state of the nation's
health system, especially, the rising cost
of healthcare services. The problem,
accordingly called for speedy action in
order to improve the deteriorating health
services in the country"
In this regard, the goal of national policy is to
ameliorate the sufferings of Nigerians arising form high
cost of health care services. Commenting on the goal of
improved healthcare services, Fadeji (2004:6).
"To achieve improved healthcare services
the federal government has launched a
number of result - oriented health
improvement programme. Among these
are the Primary healthcares Scheme, the
Guinea worm Eradication Programme,
the kick out polio Programme, Malaria
Eradication Programme and material
healthcare programme"
Most of these programmes are being implemented
with the aid of donor agencies such as the World Health
Organization (WHO) the World Bank and UNUDO.
Explaining the national policy goals on ensuring improved
health conditions and healthcare services in the country,
Ugbaja (2003:25) states that these intervention
programmes are aimed at eliminating sanitation, air and
water-bone and human waste - related diseases which
include typhoid, dysentery cholera polio and hepatitis.
Diarrheal disease, also in this group, is probably the
biggest single cause of death among children under five,
and of illness in adults.
Many worm diseases also belong to this group,
including tapeworms, hook worms and bilharzias such
air- borne diseases also included are tuberculosis,
pneumonia, diphtheria, bronchitis, whooping cough,
meningitis, influenza and measles.
Thus, Nwatu (2002:2) outlines the goals of the
national health policy to include, among other things;
- Improving healthcare delivery system.
- Improving the range of healthcare services
- Increasing the number of health institution
including teaching hospitals, specialist
hospitals, general hospital, clinics
maternities and health centers.
- Increasing the number of qualified medical
doctors, nurses and other health personnel.
- Ensuring adequacy of drugs health facilities
and equipment and beds.
- Providing adequate, effective and efficient
healthcare services at affordable costs to the
entire citizenry.
- Providing changes in knowledge, attitudes and
practice relating to sanitation, sewage disposal
and environment pollution and
- Encouraging good nutritional practices among
the people.
2.3 IMPERATIVES OF IMPROVED HEALTHCARE
SERVICES DEVELOPMENT
The essence of good healthcare system has been
Acknowledged by many well-meaning Nigerians. First, a
good and effective healthcare services promote a healthy
citizenry, healthy in the sense of minimized incidence of
diseases and ill - health. According to Abdukadri
(1998:12) a healthy citizenry is one that has a very low
mortality (infant, material and adult) rate as well as a high
life expectancy. Thus, adequate and effective healthcare
system promotes long life of the, people.
Second, it ensures higher productivity in the national
economy. Abdukadri (1998:12) also states that another
potentially significant case for improved healthcare
services is the reduction in productivity looses caused by
debility of substantial portion of the labour forces,
besides, it prolongs productive years of the labour force.
Accordingly, increases in the life expectancy of adults
would add years to the working lives (rather than
retirement years) of most adults. Other things being equal,
a lengthening of working life reduces the country's
dependency ratio.
Lower dependency ratios, of course, increase per
capital income and potentially, per capital savings, as
family incomes are required to support fever numbers.
Third, good health care services promote the peoples
standard of living. Ugbaja (2003:27) posits that a nation
with healthy population is always productive with the
individuals meaningfully earning their living. With
increasing income at their disposal, they can improve their
standard of living by satisfying most of their basic needs.
According to Grange (2007:2) efforts to improve the
nation's health care service are predicated on the
imperatives of effective and adequate healthcare system.
This depends on the ability of the government to
embark on effective health planning and formulation of
effective health policy that will benefit the populace,
especially rural dwellers who have continually been
neglected by past health policies.
2.4 FINANCING OF HEALTHCARE SERVICE IN NIGERIA
According to Lambo (2006:18) healthcare financing
in Nigeria is form a variety of sources that include
budgetary allocation from all level of government, foreign
loans and grants sector contributions and user-fee (or out
- of - pocket expenses). Public spending per capital for
health is less than $5 and can be as low as $2 in some
parts of Nigeria, which is below $34 countries within the
Macroeconomic Commission Report. According to Usman
(2005:1) although the federal government recurrent
budget with respect to health showed an improvement
from 1996 to 1998, a decline in 1999 and increasing trend
since 2000, evidence shows that the bulk of health
recurrent expenditures went to personnel. According to
Usman (2005:2) recurrent health expenditure stood at
2.55 percent in 1996 2.96 percent in 997, 2.99 percent in
1999 and increased 2001 to 2004, there was a steady
increase in the budgetary allocations, a concern in
funding health sector in Nigeria is the gap between
budgeted figures and the actual funds released from
treasury for health services.
However, Uduma (2005:3) notes that personal
healthcare expenditures account for about 90 percent of
the total having increased significantly in the first five
years of the new millennium. These have been increasing
at rate percent to 12 percent per annum when the
economy was growing at 4 percent per cent per annul the
cost structure, Uduma (2005:3) states that external
sources financed less than 20 percent of the total
expenditure. It is also shown that the domestic sources
financed much of government, individual and insurance
companies' expenditure.
External donors financed more than 20 per cent of
capital investment in the health sector.
Direct - financing methods were increasingly
advocated for as a sources of additional resources for
healthcare services delivery. Such methods include user-
fees for health services or drugs for health services or
drugs and prepayment schemes for healthcare. User-fee
method requires payment at the time healthcare services
is received while the prepayment entails a payment in
advance for the right to receive care if and when
healthcare services is needed. Ogechukwu (2004:21)
states that user- fees and drug sales are the methods
most frequently used in the public sector because of their
greater administrative simplicity and because the close
link between revenues and services makes monitoring
cash flow and book - keeping straight for - ward. In
contrast prepayment scheme requires greater financial
management expertise and involves complex
administrative duties.
Typically, the revenues generated by the user-fees
Scheme in the public sector are modest. Nwosu (2004:8) i
estimates user-fee revenues as a percentage of the current
expenditures of government health services between 1990
and 2003. The Average was only 7 percent modest
revenues from user-fee were partly due to the fact that the
government subsidized the fees for healthcares services.
And yet, even these modest revenues were not earmarked
for the financing of health services but instead went into
the general fund of the health sector.
2.5 THE NATIONAL HEALTH INSURANCE SCHEME (NHIS)
Generally, social insurance is a compulsory insurance
scheme designed to provide a minimal socio-economic
security for affected individual especially low - income
earners. According to Teriba (2005:29) it is a mandatory
insurance scheme whose objective is to provide a
minimum standard of living. It provides an answer to the
question of dependency in our society and on the
government for certain services social insurance embraces
large group of individual and the cost is sometime
distributed among participants in the scheme and,
sometimes, among all and sundry.
Ugbaja (2003:18) remarks that central to social
insurance in the health sector is the concept of social
security which, in turn, is predicated on two concepts. The
first is the responsibility of the government to see that
every one has a clam as or right to some financial
provision to meet the expenses of a large family with
respect to healthcare services. The second concept is that
government should not allow the health condition of any
individual to fall below a certain level.
This obtains essentially in advanced countries of the
west where there is effective system of social security.; In
accordance with the principles, whenever the income of a
family is inadequate to meet their health need payments
are made to them form public funds bring their health
condition to a minimum level considered acceptable vis- a
vis current standard.
According to Teriba (2004:30) contributions;for social
insurance benefits are compulsory for those concerned.
Public assistance in contrast to social insurance includes
contributions or payments directly form individual and or
employers. Usually this is financed form general tax
revenues. Under the social insurance scheme,
revenues individual is required not only to provide
security for himself and his family but also to contribute
to the needy in the community (Chikeleze, 2004:18).
According to Musa (2005:2) health insurance scheme is a
Social Security programme that guarantees the; provision
of health services to individuals on the payment of taken
contributions at regular intervals. (Chikeleze 2004:32)
defines heallth insurance as the financing of medical
expenses by means of contributions or taxes
paid into a common fund, to pay for all or par} of health
services specified in any insurance policy or law.
The legal instrument for the establishment of the
Health Insurance Scheme in Nigeria is the National Health
Insurance Scheme Act 35 of 1999. In his speech during
the inception of the scheme ex- president Obasanjo
(2005:2) gives the following as the need for or basis for the
establishment of the National Health Insurance Scheme;
i. The General Poor State of the Nation's healthcare
System.
ii. The excessive dependence and pressure on
government to fund health services
iii. Dwindling funding of healthcare in the face of
rising costs,
iv. Poor integration of private health facilties in the
nation's healthcare delivery system.
Obasanjo (2005:2) further explains that government
Hopes to achieve an efficient competitive and innovative
health care system with the following objective;
i. To ensure that every Nigeria has access to good
health care services.
ii. To protect families form the financial hardship of
huge medical bills.
iii. To limit the size of the cost of healthcare services.
iv. To ensure equitable distribution of health care
costs among different income groups.
v. To ensure efficiency in the healthcare services
vi. To improve and harness private sector
participation in the provision of healthcare
services, viii. To ensure equitable distribution of
healthcare within the of healthcare, sector for
federation.
vii. To ensure appropriate patronage of all levels.
viii. To ensure the availability of funds to the health
improved services.
2.6 NATIONAL HEALTHCARE INSURANCE SCHEME
PROGRAMMES
The national health insurance scheme Act classifies
The NHIS Programmes into the following;
i. Formula Sector Social Programme, which is
design for public servants and employees in the
organized private sector.
ii. Urban self- employed social Health insurance
Programme
iii. Rural Community Social health insurance
programme.
iv. Children under- five social insurance programme
v. Permanently Disabled persons social insurance
programme.
vi. Prison-inmates social insurance programme
vii. Tertiary institutions and voluntary participants
social health insurance programme.
viii. Armed forces polices and other unformed services
social insurance programme.
ix. Diaspora family and friends social insurance
programme.
x. International travel health insurance programme.
Currently, only the formal sector programme has
been Implemented and this covers the following;
i. Public sector employees which includes civil
servant at all level
ii. Organizations with more than 10 employees,
and
iii. Armed forces, policy and other uniformed
services (Arum, 2006:18):
2.7 HEALTHCARE SERVICES OF NATIONAL HEALTH
INSURANCE SCHEME
According to the NHIS Act, the healthcare of the
scheme to the beneficiaries includes the following;
i. Out - patient care (including consumable)
ii. Prescribed drugs as contained in the NHIS
iii. Diagnostic test as contained in the NHIS
diagnostic test list
iv. Antenatal care
v. Material care for up to four live births for every
insured person
vi. Post natal care.
vii. Routine immunization as contained in national
programme on immunization.
viii. Family planning.
ix. Consultation with a defined range of specialist
e.g. physielaris surgeons, etc.
2.8 EXCLUDED SERVICES FROM THE NHJS SCHEME
According to the NHIS Act, the flowing are excluded
from the NHIS services list;
i. Occupational/industrial injuries
ii. Epidermis
iii. Injuries from extreme sports
iv. Drug abuse/addition
v. Cosmetics surgeries
vi. High cost surgical procedures e.g. organ
transplants open-heart surgeries, etc.
vii. Provision of hearing aids
viii. Infertility management, and ix. Congenital
abnormally.
2.9 MANAGEMENT OF THE NATIONAL HEALTH
INSURANCE SCHEME (NHIS)
2.9.1 The National Health Insurance Scheme Act provides
for the Mowing in the management of the scheme;
1. National Health Insurance Scheme Council !(NHISC)
According to the act, the council (NHISC) performs
The following functions under the scheme;
i. Regulation and supervision of the scheme^
established under the NHIS Act.
ii. Issuing guideline, for remittance to Health,
Maintenance organization (HMOS) and Health
Services providers (HSPs)
iii. Establishing standard, rules and guideline for the
management of the scheme.
iv. Approving, financing, regulating and supervising
the health maintenance organization (HMOs)
and health services providers (HSPs).
v. Receiving and investigation complaints of
improperly against any HMOs or HSPs.
2.9.2 HEALTH MAINTENANCE ORGANIZATION (HMOS)
These are individual organization empowered by the NHIS
Act to Play the rule of a contractor under the scheme by
lessoning between the National health insurance scheme
council and the health services providers. They directly
coordinate and oversee the activities of the HSPs with
respect to provision of the service under the scheme.
The NHIS Ac empowers the HMOs to carry out the
following functions under the scheme;
i. Open account for the Health Service Providers
registered with (each of) them,
ii. Receive the contributions by the government and
workers via the National Health Insurance Scheme
Council.
iii. Make payment to health services providers tor
medical services provided for public servants
registered with them.
iv. Oversee the activities of Health Service Providers.
2.9.3 HEALTH SERVICES PROVIDERS (HSPs)
These are the healthcare institutions registered by
the National Health Insurance Scheme Council to provide
health services to the people under the scheme. These
institutions are classified into the following;
1. Primary Healthcare Providers:- These include
community health centers, private clinics, hospital
and maternity.
2. Secondary Healthcare Providers: - These include
state government general hospital and big private
hospitals.
3. Tertiary Health Providers:- These include specialist
and teaching Hospital which serves essentially the
scheme.
According to the Act, the functions of Health Services
providers include;
2.9.4 FUNDING OF THE SCHEME
According to Usman (2005:6) National Health
Insurance Scheme (NHIS) is a contributory scheme in
which both the employer and employees contribute to a
common fund? Contributions are earning - related. In
other words each workers contributes a specific proportion
of his/her monthly or annual basic salary to the fund.
Initially, contribution represented 15 per cent of basic
salary.
The government paid 10 percent while the workers
paid 5 percent. But since January 2007 workers have
started paying the 15 percent. A monthly capitation is
paid to the primary health services provider fee-for-
service is paid to all secondary health service providers
while per diem is paid for hospital bed space. There is also
co-payment for drugs received from primary health
services providers in which the recipient pays only 10
percent of the total cost of drugs received at
instance.
2.9.5 OPERATIONAL PROCEDURES AND COVERAGE
The National health insurance scheme (NHIS) allows
each Individual worker to decide and choose a health
services providers with which to register for medical or
health services. For each .worker, the scheme covers;
- Him/her (her insured known as the principal)
- A spouse (the wife or husband) and
- A Biological child. The scheme doers not provide
coverage for dependently, an NHIS ID card is then
given to the principal and each of the registered
member of the family with which the health services
provider visited for medical attention and treatment.
According to Arum (2006:17) for treatment and drug
Administered on any of he beneficiaries only 10 paid to the
HSp There is no limit to the number of visit at any given.
2.10 EVALUATION OF THE NHIS
Conceptually, NHIS is a welcomed innovative and
development in the Nigeria health sector given its
objective. However, Its effectiveness, or otherwise, can only
be determined by the extent to which it has achieved its
objectives. The following questions should be addressed in
evaluating the effectiveness of NHIS.
1. To what extent has the scheme improved the
general state of the nation's healthcare system?
2. To what extent has the scheme reduced
dependence on government funding of health
service in the country?
3. To what extent has the scheme contributed in
increasing the funding of health care?
4. To what extent has the scheme integrated the
private sector health facilities in the nation's
health care delivery system? With respect to
improvement in the general state of the nation's
Health care system, Nwosu (2002:9) scores the
scheme fairly high especially for public servants
who now benefit from the benefits the scheme.
They now receive much attention and are given
adequate treatment in public hospitals. But
Arum (2006:11) argues that the scheme has
limited success since the larger segment of the
Nigerian society are not yet benefiting from the
scheme.
Only federal public servants benefit now as only the
public sector programmes has been implemented Bothers
that would beneficial to the society at large.
On reduction of dependence on government for
funding health services, Arum (2006:11) acknowledges
that the scheme has reduced the burden on the
government and improved the funding of health service
through its contributory strategy. The 15 percent
deduction form basic salaries of workers, which are
remitted to the NHIS and the co-payment system, have all
increased healthcare funding.
The scheme however, has been rated iow in the
integration of private sector healthcare delivery system.
According to Lambo (2006:12) most of the health service
providers are; government owned hospital. Few private
health institutions operate the scheme. While some have
stopped the scheme so many others refuse to register
additional clients. It is also observed that most of them
lack the personnel and requisite facilities for operation of
the scheme.
Nevertheless, Teriba (2005:31) states that most of the
objectives of NHIS are far from being achieving two years
after its take- off. For instance not every Nigerian has
access to good healthcare service under the scheme
because of poverty, high cost of drugs and lack of
healthcare facilities.
Many are still facing financial hardship caused by
huge medical bills. Only few hospitals provide high
standard healthcare services. Furthermore, ensuring
equitable distribution of healthcare services through out
the federation under the scheme is still far - fetched.
2.11 PROBLEMS AND PROSPECTS OF THE NHIS
Currently, the implementation of NHIS has nor been
easy in inadequate physical health facilities and
personnel, administrative and logistics bottlenecks. The
nation does not have enough healthcare providing
institutions with adequate medical facilities and personnel
for effective implementation of the scheme besides, the
administration of the scheme has not been easy given the
delays in processing document of registered beneficiaries
and remitted contributions to the NHIS and HMOS and
HSPs.
Furthermore, the informal sector is very difficult to
organized for the scheme. Even private hospital and clinic
are becoming unwilling to embrace the scheme.
Nevertheless, the seems to be prospects for the
success of the scheme. As Usman (2005:6) points cut, the
increasing political commitment or government support as
well as 'international Donor Agent as support for the
scheme indicate prospects for the scheme in Nigeria.
Besides, many organized private sector enterprises now
bracing up for the scheme.
REFERENCES
Abdukadir M. (1998:12) "Imperatives of Effective
healthcare system" Medical Journal. Vol. 12 No 3.
Arum, R (2006:18) "NHIS at one" The Guardian. Thursday,
June 6. Babangida, I (1989:12)"Budget Speech"
Daily Times. Wed. Jan. 10 Chikeleze, 6(2004:18)
Principles of Insurance. Enugu: Precision.
Dimeji, L (2000:10) "Healthcare Services in Nigeria in
Perspectives Medicare. November.
Fadeji, 0 (2004:6) "Goals of Nigeria's health Policy" Medical
Journal. Vol. 16 No 3.
Grange, A (2007:2) "Improving Healthcare; services
through insurance Scheme" Daily Times Nov. 24.
Lambo, E (2006:16) "NHIS and The Nation" Health News.
June 16.
Mba, T (2002:8) "Primary Health care Service and
Millennium Development Goals" (A policy paper
presented to National Planning Committee).
Nwatu, R (2002:2) "Need for A Health Insurance :Scheme
in Nigeria" The Source. October.
Nwosu, A.B.C (2002:8) Healthcare Financing in Nigeria;
2000-2003" Medical Journal. Vol. 21 No 3.
Obasanjo, 0 (2005:2) "The NHIS" (A policy Paper presented
to the National Executive Council on Mar. 15,
2005.
Ogechukwu, P(2004:21) "Healthcare Services financing in
Nigeria" Medical Journal Vol. 16 No3.
Ransome - Kuti, 0 (1992:17) "Imperatives of An iEfficient
Healthcare Services Delivery" Community
Medicine. Vol. 6 No 2.
Soyinka, W (2001:19) "Health for All by 200p : All by 2000:
A Mirage?" News watch Monday, September 30.
Teriba, J (2005:29) "The NHIS so far" Vanguard . THE July
26. Uduma, P (2005:3) "Making The NHIS work"
The Sources August 10.
Ugbaja, C.O (2003:26) "Alternative method of Healthcare
financing" Community Medicine. Oct - Dec.
Usman, A (2005:1) "The National Health Insurance
Scheme Public Sector reforms December.
World Health Organization (2001:42) Social Development
Indices Vol. 35 No 10.
CHAPTER THREE
RESEARCH METHODOLOGY
In this chapter, the researcher states ; and explains
the procedure adopted and techniques employed in
carrying out this study.
3.1 RESEARCH DESIGN
By its methodology, this study is a descriptive survey
research. Through the survey carried out on a sample of
respondents randomly selected from the study population,
primary data were collected. Secondary data were
collected through review of related literature, text, and
journals, etc.
In data analysis, the researcher used tables in the
presentation. In the analysis, the techniques of frequency
and percentage were applied.
3.2 AREA OF STUDY
This was carried out in five establishments in Enugu
metropolis.
3.3 SOURCES OF DATA
Data were collected through primary and secondary.
a) Primary Sources
These are sources that provide first – hand data i.e.
data that had not been produced and published
earlier. These include the respondents and those
orally interviewed.
b) Secondary Sources
These are sources of second hand data i.e. data that
had been produced and published earlier. They
include textbooks, journals, magazines, periodicals,
conference, workshop and seminar papers.
3.4 POPULATION
This consisted of management and staff of [National
Healthcare Insurance Scheme, Health Management
Organizations and Health Service Providers in Enugu.
They were 159 in number as at the time of this study.
3.5 SAMPLE SIZE DETERMINATION AND
SAMPLING TECHNIQUE
The Yaro Yamanisl (1960:240) technique was used in
determining the sample size as follows;
n = N i
1 + N (e)2 !
Where N = Population
e = Level of significance
I = A constant value.
n = 159
159(0.05)
= 159
1 +159(0.05)2
= 159
1 + 0. 397
= 159
1. 397
113.57
= 114 approximately
A total of 114 staff of the five establishments were
selected. The method of selection is the simple random
sampling technique.
3.6 INSTRUMENT
The main instrument used in the data collection is
the questionnaire. This instrument contains both
structured and unstructured questions. The structured
questions provide optional answers to the questions from
which an answer should be selected.
The unstructured questions allow the respondents to
provide answers by themselves.
An interview schedule was also used in the data
collection. It is designed to generate only oral answers.
3.7 DATA COLLECTION PROCEDURE
The researcher personally went to the establishments
in their various locations in Enugu metropolis and
administered the questionnaires to the staff who were
randomly selected for the study. Being self- reporting, the
questionnaire was left with the respondents for completion
within two days. However, those who could do so
completed their copies on- the- spot. The researcher
retrieved the questionnaires after two days one hundred
and five (105) copies wee retrieved representing 92.1%
return rate.
3.8 DATA ANALYSIS TECHNIQUE
The data are presented in tables as frequency
distribution. In the analysis, the technique of percentage
and frequency are applied. In setting the hypotheses,
the Z test is applied. This entails calculating the value of Z
as follows;
Z = P-Po
Po (1 - Po)
N
Where P = Proportion of positive responses to variable of
interest
Po = Probability of rejecting
N = Total Respondents
I = A constant
Then the computer Z is compared with its critical value at
P = 0.05 which is 1.96
Decision - Rule
Reject Ho and accept Hi, if the computed Z is more
than 1. 96, and reject Hi and accept Ho, if the computed z
is less than 1.96.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
In this chapter, the research present and analysis the data
collected from the respondents.
TABLE 4.1 ADMINISTRATIONS OF QUESTIONNAIRES
QUESTIONNAIRES NO %
a) Distributed 114 100
b) Returned 112 98.2
c) Not Returned 2 1.8
d) Discarded 2 1.8
e) Analyzed 110 96.4
The table shows that 98.2% of the questionnaires
were returned. 1.8% was not returned. 1.8% was
discarded; hence, 96.4% were analyzed.
TABLE 4.2 SEX DISTRIBUTIONS OF RESPONDENTS
SEX NO %
Males 62 56.4
Female 48 43.6
TOTAL 110 100
This shows that 56.4% are males while 43.6% are
females.
TABLE 4.3. AGE DISTRIBUTION OF RESPONDENTS.
[AGE (YRS) NO %
Under 30 20 1
8
.2
30- 39 25 2
2
.7
40-49 28 2
5
.5
50-59 25 2
2
-7
60 and above 12 1
0
.9
TOTAL 110 100
i i
The table shows that 18.2% were below $0 years old
22.7% were within 30 - 39 years old. 25.5% were within
40 - 49 years old 22.7% were within 50 - 59 years of age
while lb.9% were 60years old and above.
TABLE 4.4 MARTIAL DISTRIBUTION OF
RESPONDENTS
MARTIAL STATUS NO %:
i Single 37 33.6
Married 61 55;.5
Others 12 10.9
TOTAL 110 100
j
This shows that 33.6% were single 55.5%;were
married while idows, widowers and divorces constitute
10.9%.
TABLE 4.5 HIGHEST EDUCATIONAL OF RESPbNDENTS
QUALIFICATION NO °4
i
i
FSLC - i i
•• t
j
WASC/GCE 16 14.5
OND/NCE 18 16.4
HND/BSC/Equiv 49 44.5
i MBA/MSC/Equiv 20 1£.2
Others 17 15.4
TOTAL 110 100
i
The table shows that none held FSLC 14.5/o held
WASC/GCE 16.4% held IND/NCE 44.5% held
HND/BSC/Equir 18.2% held professional qualification
in accountancy, finance and management.
TABLE 4.6 ORGANIZATION DISTRIBUTIONS OF
RESPONDENTS
ORGANIZATION NO %
National Health Insurance Council 28 25.5
Health Maintenance Organizations 45 40.9
Health Providers 37 33.6
TOTAL 110 100
From the above, it can be seen that 25.5% of the
respondents were drawn from the National Health
Insurance council (NHIS), 40.9% were drawn from Health
Maintenance Organization (HMOs) while 33.6% were
drawn from Health Service I Providers (HSPs). These are
the managers of the NHIS. While the; HMOs supervise it
and the HSPs implements it.
TABLE 4.7 RESPONSES TO NHIS FULLY
OPERATIONAL IN me PUBLIC SECTOR.
OPTIONS NO «/ /o
Yes 110 1 10
No - -
TOTAL 110 1fO
The table shows that all the respondents agree that
the NHIS are fully operational in the public sector. This
means that all the ministries, Extra - ministries, agencies,
commissions and parastatals are now implementing the
scheme. However, it should be pointed out that this
related or affects only federal public Service the national
healthcare system. 56.3% indicate that all these factors
are the rational for the public sector.
This means that the NHIS is designed to address the
problems and challenges in the national healthcare
system.
TABLE 4.8 GOALS OF THE NHIS
OPTIONS NO %
Access to good healthcare services for all 10 9.1
Equitable distribution of healthcare costs and
facilities
9 8.2
High standard of healthcare services 6 5.5
Availability of funds to the health sector 12 11
Greater integration of private sector health
institutions in the nation's healthcare
system
8 7.2
All of the above 65 59.0
TOTAL 110
j
100
From the table, it can be seen that 9.1% and 8.2%
indicated that the goal of the NHIS is to give access to
good healthcare services to all Nigerians and to ensure
equitable distribution of healthcare costs and facilities
respectively, 5.5% and 11% indicate that it is to ensure
high standard of healthcare services and availability of
funds to the health sector respectively 7.2% indicate that
it is to ensure greater integration of private sector health
institutions into the nation's healthcare system. 59%
indicate that all these factors are the goals of the NHIS
This implies that the NHIS is conceptualized against
the background of poor and costly healthcare system and
it, this designed to improved it.
TABLE 4.9 RESPONSE TO NHIS AIMING AT
ACHIEVING EFFICIENT HEALTH CARE SERVICES
DELIVERY.
OPTION NO O/ ! I
I Yes 110 1Q'0
No - i
TOTAL 110 100
The table indicates that all the respondents agree
that the NHIS aims at achieving healthcare services
delivery. Through joint financing healthcare costs are
reduced for the administration of the scheme to private
organizations efficient services are targeted while
integration of the private sector health facilities into the
scheme is to ensure efficiency of the health sector
nationally.
TABLE 4.10 NHIS FUNDING STRATEGY
OPTIONS NO %
Workers' contributions only - -
Government's contributions only - -
Joint contributions by workers
and government
36 32.7
Capitation 21 ;19.1
C and d above 53 48.2
TOTAL 110 100
TABLE 4.11 MANAGERS OF NHIS
OPTION NO %
NHI council 13 11.8%
Health Maintenance Organization
(HMOs)
18 16.4
Health service Providers (HSPs) 12 10.9
All of the above 67 60.9
i TOTAL 110 100
I
From the table, it can be seen that 11.8% land 16.4%
indicate that the manager of the NHIS the Natural Health
insurance council (NHIC) and Health Maintenance
Organization (HMOs) respectively. 10.9% indicate that it is
the health service Providers (HSPs). But 60.9% indicate
that all these are the managers of the scheme.
The National Health insurance Council is the regulatory
institution s while the health maintenance organizations
are the supervisory body. The Health Service Providers are
the implementations.
TABLE 4.12 ROLES OF THE NHIC
OPTIONS NO %
Regulates the scheme ,
•i
12 10.9%
Receives remittances from government
establishment
11 10
Releases collections to HMOs 10 9.1
Appoints and approves HMOs and HSPs for the
scheme
i i
12 10.9
Receives and investigates complaint against
HMOs and HSPs
8 7.3
Sanctions defaulters 6 5.5
All of the above 51 46.3
TOTAL 11 100
This shows that 10.9%, 10% and 9.1% of the
respondents indicate that the role of the council in the
scheme is regulation of the scheme receiving remittances
from government establishments and releasing collections
to HMOs respectively. 10.9%, 7.3% and 5.5% indicate that
it is appointing approving HMOs and HSPs for the
scheme, receiving and investigating complaints iagainst
HMOs and HSPs, and sanctiong defaulters respectively.
46.3% indicate that the council play all these roles.
This implies that the NHIC is the apex institution
whose role in the scheme is essentially regulatory and
supervising.
TABLE 4.13 ROLE OF THE HMOS
OPTIONS NO %
Open accounts for HSPS 8 7.3
Receive remittances from NHIC on behalf of
HSPs
12 10.9
Make payment to HSPs 13 11.8
Supervises the HSPs. 15 13.6
Render reports to NHIC 10 9.1
All of the above 52 47.3
TOTAL 110 100
The table shows that 7.3%, 10.9% and 11.8%
indicate that the role of the HMOs under the scheme is
opening of payment accounts for HSPs, receiving
remittances from NHIC on behalf HSPs and making
payments to HSps respectively. 13.6% and 9.1% indicate
that it is supervision of HSPs and rendition of reports to
NHIC respectively. 47.3% indicate that HMOs play all
these roles.
This implies that HMOs supervise and oversee the
operations of HSPs.
TABLE 4.14 ROLE OF HSPS
OPTIONS NO %
Provide health care services to clients 18 16.4
Receive capitation from clients 9 8.2
Offer healthcare personnel and facilities 15 13.6
All of the above 53 58.2
Others 15 13.6
TOTAL 110 100
The table shows that 16.4% and 8.2% indicate that
the role of HSPs is to provide healthcare services to clients
and receive capitation from clients respectively.
13.6% indicate that the role is offer of healthcare
personnel and facilities for the scheme while 58.2%
indicate that all these are the role of HSPs in the scheme.
13.6% indicate other roles which include marking and
implementing the scheme.
The benefits of the scheme outlined by the
respondents include
i. Adequate healthcare services in hospitals
ii. Quick and prompt attention in hospitals
iii. Extend healthcare service to family members
and dependents
iv. Reduced healthcare costs
v. Access to more healthcare facilities and vi.
Availability of more healthcare services. TABLE
4.15 PROBLEMS OF NHIS
OPTIONS NO %
Inadequate HSPs 7.1 64.5
Inadequate healthcare facilities and personnel 73 66.4
Delays in making remittances to HMOs and
HSPs
81 73.6
Refusal of HSPs to take on more clients 43
i
39.1
Withdrawal of manty HSPs from the scheme 35 31.8
Limited coverage 39 35.5
The respondents also outlined perceived inherent
problems in the scheme. These include inadequate HSPs
(64.5%); inadequate healthcare facilities and personnel
(66.4%); delays in making remittances to HMOs and HSPs
(73.6%); refusal of HSPs to take on more clients (39.1%);
withdrawal of many HSPs from the scheme (31.8%) and
limited coverage (35.5%). Limited coverage mens that the
scheme is for now operational in the federal public
services only.
TABLE 4.16 RESPONSES TO THE SCHEME HAVING
PROSPECTS FOR SUCCESS
OPTIONS NO %
Yes 81 73.6
No 29 26.4
TOTAL 110 100
The table shows that 73.6% agree that there are
prospects for the success of the scheme while 26.4%
disagree.
TABLE 4.17 RESPONSES TO NHIS PROBLEMS!
BEING ESSENTIALLY ADMINISTRATIVE.
OPTIONS NO %
Yes : 72 65.5
No 38 34.5
TOTAL 110 100
From the table it can be seen that 65.5% agree that
the problems of the NHIs are essentially administrative
while 34.5% disagree. Administrative problems an'se from
the way the scheme is managed and do not arise from
outside the system.
4.2 TEST OF HYPOTHESIS
We shall now apply the technique described in 3.8 to
test the hypothesis stated in 1.5
Hypothesis 1.
Ho; the rational for the NHIS is not the general poor state
of the nation's healthcare system
Hi; the rationale for the NHIS is the general poor state of
the nation's healthcare system Data in table 4.8
indicate that;
P = 13 + 62 =95 = 68.1% =0.68
P0 = 0.5
N = 110
0.68-0.5
N = 110
Z= 0.68-0.5 0.5
(1-0.5)
110
= 0.18
0.25
110
0.18
0.0023
0.18
0.084
= 3.75
Based on the decision - rule, we reject H0 and accept
K i.e. since 3.75 > 1.96
[
HYPOTHESIS 3
Ho; the problems of the NHIS are not essentially
Administrations
Hi; The problem of the NHIS are essentially administrative
From table 4.16, we have;
P = 72 = 65.5% = 0.66
Po = 0.5
N = 110
Z = 066 – 05
0.5(1 - 0.5)
110
= 0.16
0. 048
= 33
Since 3.3 > 1.96, we reject H0 and accept H,
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION 5.1
SUMMARY OF FINDINGS
- The National Health insurance scheme, incepted on
6th June 2005 is meant to improve health care services in
Nigeria. The rationale include the general poor state of the
nation's health care system, over - dependence on
government for healthcare delivery, dwindling healthcare
financing, rising cost of healthcare services and poor
integration of healthcare institution the nation's
healthcare system.
- The goals of the NHIS include accessing good health
care services for all Nigerians, ensuring equitable
distribution of health care costs and facilities, high
standard of healthcare services, availability of funds to the
health sector and greater integration of private sector
health institutions into the nation's healthcare system.
- The system is funded through joint contributions by
public servants and government and capitation paid by
beneficiaries. The managers of the scheme are the
National Health Insurance council (NHIC), Health
Maintenance Organization (HMOs) and Health Services
Providers (HSPs).
- The role of the NHIC include regulating the scheme,
receiving remittances from government establishments,
releasing collections to HMOs and HSPs for the scheme,
receiving and investigating complaints against HMOs and
HSPs and sanctioning defaulters in the scheme.
- The role of the HMOs include opening accounts for
HSPs receiver remittances from NHIC, making payments
and HSPs, supervising HSPs and rendering reports to NI-
JIC. The role of the HSPs include providing healthcare
services to clients, receiving capitation from clients, offer
health care personnel and facilities for the scheme, etc.
- The benefits of the scheme include adequate
healthcare services in hospitals, quick and prompt
attention in hospitals, extended healthcare services to
family members and dependents, reduced healthcare costs
access to more healthcare services and availability of more
healthcare services.
- The problems inherent in the scheme include
inadequate HSPs and healthcare personnel and facilities,;
delays in making remittances to HMOs and HSPs, refusal
of HSPs to take on more clients, withdrawal of many HSPs
from the scheme and limited coverage.
5.2 CONCLUSION
The National Health Insurance Scheme, which was
Incepted against the background of the general poor state
of the nation's healthcare system, is aimed at improving
healthcare services and delivery in Nigeria by making
good healthcare services accessible to all Nigerians. By
being financed through government and workers
contribution the scheme is intended to reduce the rising
costs of healthcare services and make them affordable to
the people.
If effectively implementation the scheme will improve
the utilization of private sector health personnel and
facilities in the nation's health care system. There are
much prospects for the success of the scheme despite its
inherent weaknesses and challenges
5.3 RECOMMENDATIONS
The following measures are recommendation for
effective operation of the NHIS in Nigeria;
1. The government should ensure adequate) number of
health personnel and facilities for the scheme. This can be
achieved by getting more of the private sector health
facilities into the scheme. Their under- utilized personnel
and facilities can be put to maximum use under the NHIS.
2. Government should attract more HSPs to the scheme
through incentive schemes. This can be through better
financial rewards and concessions, provision of more
health facilities among others. This will address the
problems of) refusal to take on more clients and
withdrawing from the scheme by private sector he scheme
by private sector health institutions.
3. The government should also facilities the
Administration of the scheme by ensuring prompt
remittance of contribution to the NHIC which, in turn,
should immediately upon receipt of the money ensure
prompt payments to HSPs.
4. The NHIS scheme should continuously review this
scheme to ensure that it operates in a manner that will
ensure the justification of its implementation and
achievement of its goal. In this regard, it should ensure
that its officials are frequently up dated through
workshops and seminars.
5. The scope of the scheme should be extended to the
private sector where millions of Nigerians are yet to benefit
from the scheme. The government should expedite action
in establishing the necessary framework requisite for
implementation of the programmes of the scheme to the
benefit of all Nigerians.
BIBLIOGRAPHY
Chikeleze, 6(2004:18) Principles of Insurance. Enugu:
Precision Printers.
Olaghere, A (2000:42) "Health financing in Nigeria" Social
Insurance (ed) Lagos: liupeju publishing co.
JOURNAL/MAGAZINES
Abdukadir M. (1998:12) "Imperatives of Effective
healthcare system" Medical Journal. Vol. 12 No 3.
Dimeji, L (2000:10) "Healthcare Services in Nigeria in
Perspectives Medicare. November.
Fadeji, O (2004:6) "Goals of Nigeria's health Policy"
Medical Journal. Vol. 16 No 3.
Lambo, E (2006:16) "NHIS and The Nation" Health News.
June 16.
Nwatu, R (2000:12) "Making the health system Effective"
Medical Journal. Jan.
Nwosu, A.B.C (2002:8) Healthcare Financing in Nigeria;
2000-2003" Medical Journal. Vol. 21 No 3.
Ogechukwu, P(2004:21) "Healthcare Services financing in
Nigeria" Medical Journal Vol. 16 No3.
Ozuh, I (2004:30) "The National Health Insurance Scheme"
Bullion Vol. 23 No 10.
Ransome - Kuti, O (1992:17) "Imperatives of An Efficient
Healthcare Services Delivery" Community
Medicine. Vol. 6 No 2.
Soyinka, W (2001:19) "Health for All by 2000 : All by
2000: A Mirage?" News watch Monday, September
30.
Uduma, P (2005:3) "Making The NHIS work" The Sources
August 10.
Ugbaja, C.O (2003:26) "Alternative method of Healthcare
financing" Community Medicine. Oct - Dec.
Ughanmadu, C (2003:23) "Health and National
Development" Medical Journal. Vol. 20 No 3.
Umar, A (2006:13) " Improving the health sector through
social insurance. The vanguard. Tue June 10.
Usman, A (2005:1) "The National Health Insurance
Scheme Public Sector reforms December.
World Health Organization (2001:42) Social Development
Indices Vol. 35 No 10.
NEWSPAPERS
Abacha, S (1985:3) "Why Buhari was sacked" Daily Times
Thurs. August 29.
Arum, R (2006:18) "NHIS at one" The Guardian. Thursday,
June 6. Babangida, I (1989:12)"Budget Speech"
Daily Times. Wed. Jan. 10
Grange, A (2007:2) "Improving Healthcare services
through insurance Scheme" Daily Times Nov. 24.
Teriba, J (2005:29) "The NHIS so far" Vanguard. THE July
26.
Umar, A (2006) "Improving Health Sector\Service Through
Social Insurance" The Vanguard. The June 10.
WORKSHOP/CONFERENCE PAPERS etc.
Mba, T (2002:8) "Primary Health care Service and
Millennium Development Goals" (A policy paper
presented to National Planning Committee).
Obasanjo, O (2005:2) "The NHIS" (A policy Paper
presented to the National Executive Council on
Mar. 15, 2005.
Oduemyi, 8(2003:21) "Alternative health care financing" A
conference paper.
APPENDIX
Department of Management Facility of Business Administration UNEC of Post Graduate Studies 1st June 2008
Dear Respondent,
I am a student in the above named institution
carrying out a study on Management of the National
Health Insurance scheme in the Nigerian Public sector. I
want you to fill out this questionnaire for me. The purpose
of this study is for academic. Thus, the information you
provide will be used for no other purpose.
Thanks for your cooperation.
Yours faithfully,
OHALETE CHIGOZIRI AGUNOBI
QUESTIONNAIRE
Instruction: Please, tick () in the box that depict your
answer.
Otherwise, answer the question where necessary.
Q1. Name -------------------------------------------------------
Q2 Sex; (a) Males (b) Females
Q3. Age -------------------------------------------------------
Q4. Marital Status; (a) Single (b) Married
(c) Others (specify)
Q5. Highest education qualification held?
a) OND/NCE (b) HND/BSC/Equiv
c) FSLC (d) WASC/GCE
e) MBA/MSC/Equiv (f) Others (Specify)
Q6. To which of the following do you belong?
a) National Health Insurance Council
b) Health maintenance Organization
c) Health Service Providers
Q7. Is the NHIS fully operational in the public sector?
a) Yes (b) No
08. What is the rationale for the NHIS?
a) General poor state of the nation's healthcare
system
b) Over dependence on government for healthcare
delivery
c) Dwindling healthcare financing
d) Rising cost of health care services
e) Poor integration of private sector health
institution in the nation's healthcare system
f) All of the above
Q9. What are the goals of the NHIS?
a) Access to good healthcare services for all
b) Equitable distribution of healthcare cost and
facilities
c) High standard of healthcare services
d) Availability of funds to the health sector
e) Greater integration of private sector health
institutions in the nation's healthcare system
f) All of the above
Q10. Do you agree that the NHIS aims at achieving
efficient healthcare delivery?
a) Yes (b)No
Q11. How is the scheme funding?
a) Workers' contributions only
b) Government's contributions only
c) Joint contributions by workers and government
Capitation
Q12. Which bodies manage the NHIS?
a) NHIS council
b) Health Maintenance organization
c) Health service Providers
d) All of the above
Q13. What is the role of the NHIS council?
a) Regulation the scheme
b) Receives remittance from government establishments
c) Releases collection to HMOs
d) Appointing and approving HMOs and HSps for the
scheme
e) Receiving and investigating complaints against
HMOs and HSPs
f) Sanctions defaulters
g) All of the above
Q14. What is the role of the HMOs in the scheme?
a) Open accounts for HSPs
b) Receiver remittance from NHIS council
c) Make payment to HSPs
d) Render reports to NHIS
e) All of the above
Q15. What is the role of the HSPs?
a) Providers healthcare services to clients
b) Receive capitation from clients
c) Offer healthcare personnel and facilities
d) All of the above
e) Others (specify)
Q16. Outline the benefits of the scheme known to you?
--------------------------------------------------------------------
Q17. Do you agree that the problems of the NHIS are
essentially administration?
a) Yes (a) No
Q18. What are the inherent problems in the scheme?
a) -------------------------------------------------------
b) -------------------------------------------------------
c) -------------------------------------------------------
d) -------------------------------------------------------
Q19. Do you agree that there are prospects for the success
of the scheme?
a) Yes (b) No
Give your reason--------------------------------------------------
