1.1 BACKGROUND TO THE STUDY
Ever since Emperor Otto Von Bismarck of Germany enacted the
mandatory legislation on the “sickness funds” for working Germans in
1883, different models of health insurance have continued to evolve
worldwide albeit with the same general insurance principles. In the
developed world, insurance in one form or the other is a veritable and
sustainable tool for financing healthcare. The National Health
Insurance (NHIS) was launched in Nigerian on October 15, 1997 and was
passed into law in May 1999. The original scheme has been modified to
include healthcare for less privileged persons in the country (FMH,
According to the World Health Organization (WHO)
in 2005, Nigeria was ranked 197th out of 2000 nations; life expectancy
was put at 48 years for male and 50 years for female while healthy life
expectancy (HALE) for both sexes was put at 42 years. Nigeria accounts
for 10% of global maternal mortality with 59,000 women dying annually
from pregnancy and child birth; only 39% are delivered by skilled
health professionals. In order to provide equitable distribution of
health, the NHIS was introduced in Nigeria. The need for the
establishment of the scheme was informed by the general poor state of
the nation’s healthcare services, excessive dependence and pressure on
the government’s provision of health facilities, dwindling funding of
health care in the face of rising cost, poor integration of private
health facilities in the nation’s healthcare delivery system and
overwhelming dependence on out – of - pocket expenses to purchase
Like any other insurance scheme, the premium for
the NHIS is the amount charged by the insurance compared with the
promise to pay for any eventual “covered medical treatment” for the
designated “coverage”. Consequently health insurance makes it possible
to substitute a small but certain cost for a larger but uncertain loss
(chain) under an arrangement in which the healthy majority compensate
for the risks and costs of the unfortunate ill minority. The NHIS
currently represents 15% of one’s basic salary. The employer is to pay
10% while the employee contributes 5% of his/her basic salary to enjoy
healthcare benefits. The contribution made by the insured person
entitles his/her spouse and four children under the age of 18 to full
health benefits (FMH 2005).
NHIS was designed to provide minimum economic
security for workers with regard to unfavorable losses resulting from
accidental injury, sickness, old age, unemployment and premature
death of family wage earner. NHIS is made compulsory because the
government based on past experiences predicted that some citizens
cannot engage in the scheme and the government also has the duty to
protect the general welfare of all citizens (Ibiwoye and Adedeke,
2007). It is also the government’s belief that NHIS will help to break
the vicious cycle of poverty in the country. It is also a form of
social support for workers (Jutting, 2003). There is lack of health
care coverage and little equity. Access to healthcare is limited and
most Nigerians are unable to pay for health services and health
facilities are far from being equitably distributed. All these
contributed to the limitation in health services (Samin and Awe, 2009).
The available health services are very expensive and the common man
cannot afford it; only the privileged few can get access to good
health. This study aims at assessing the level of knowledge, awareness
and benefits of NHIS to the civil servants in Uyo LGA.
1.2 STATEMENT OF THE PROBLEM
Insurance is a veritable tool for healthcare financing, it has
been used by most advanced countries in its various forms to fund
healthcare. It is only recently being applied by poorer developing
nations to address the glaring problem of inadequate healthcare
provision, which was hitherto financed exclusively from public
taxation. The health sector can be subdivided into two main categories,
healthcare infrastructure and healthcare financing. Health funding
relates directly to all production and financial activities and
resources expended on goods and services consumed by or provided to the
human population for the purpose of improving health.
Awareness and interest towards government
policies and programs can be aroused by individual attitude and
behaviour. Whenever there are negative perception and attitude and
knowledge towards these policies and programs, such policies and
programs are bound to fail. Awareness of these government programs and
activities makes the governed to have positive attitude and perception
towards these programs, thus, improving their participation and
responsiveness to these programs. The National Health Insurance Scheme
(NHIS) was introduced in Nigeria with the promulgation of degree No. 35
of 1999.5 with the broad objective of ensuring that every Nigerian has
access to good health care services at affordable costs. Participants
are expected to pay capitation fees to licensed Health Maintenance
Organizations (HMOs), which would allow the subscriber to have access
to registered health care providers. In this degree, Federal Executive
Council approved National Health
Insurance Council (NHIC) as an omnibus regulator of the entire
NHIS, which perhaps will correspond to the institution/corporate body.
Also National Health Insurance Fund (NHIF) was established to manage
deductions from public sector employees and employers while HMO would
receive contributions from their organized private sector counterparts.
These study seek to determine the level of knowledge, awareness and
benefits of NHIS among civil servants in Uyo LGA.
1.3 OBJECTIVES OF THE STUDY
The following are the objectives of this study:
- To examine the level of knowledge and awareness of NHIS among civil servants in Uyo LGA.
- To identify the benefits of NHIS among the civil servants in Uyo LGA.
- To determine the factors limiting the successful implementation of NHIS in Uyo LGA.
1.4 RESEARCH QUESTIONS
- What is the level of knowledge and awareness of NHIS among civil servants in Uyo LGA?
- What are the benefits of NHIS among the civil servants in Uyo LGA?
- What are the factors limiting the successful implementation of NHIS in Uyo LGA?
1.6 SIGNIFICANCE OF THE STUDY
The following are the significance of this study:
- Given the inefficiencies experienced in public hospitals, it
was expected that the populace would readily embrace the scheme. For
some reason this does not appear to be the reality. Outcome of this
study will increase the knowledge, awareness of NHIS in Uyo LGA by
making the civil servants understand the benefitsd of the scheme.
- This research will also serve as a resource base to other
scholars and researchers interested in carrying out further research in
this field subsequently, if applied will go to an extent to provide
new explanation to the topic
1.7 SCOPE/LIMITATIONS OF THE STUDY
This study will cover all the objectives of NHIS and the benefits
with a view of increasing the knowledge and awareness of the scheme.
LIMITATION OF STUDY
Financial constraint- Insufficient fund tends to
impede the efficiency of the researcher in sourcing for the relevant
materials, literature or information and in the process of data
collection (internet, questionnaire and interview).
Time constraint- The researcher will
simultaneously engage in this study with other academic work. This
consequently will cut down on the time devoted for the research work.
Federal Ministry of Health Abuja FMH (1998). The National Health
Policy and strategy to Achieve Health for all. FMH, Abuja.
FMH (2005). Operational Guideline of National Health Insurance Scheme. FMH Abuja.
Jutting J (2003). Health Insurance for the poor – Determinants of
participation in Community Based Health Insurance Scheme in Rural
Areas, Elsevier Ltd Paris
Ibiwoye A, Adeleke AA (2007). The Impact of Health Insurance on
Healthcare provision in Developing countries. Ghananian J. Development
Stud. 4 (21) 49-58
Sanusi RA, Awe AT (2009). An assessment of Awareness level of
National Health Insurance Scheme consumers in Oyo state Nigeria. The
Medwell J. 4 (2) 143-148.