Addressing the Challenges of Health Care Delivery System in Nigeria Through Aggressive Implementation of the National Health Insurance Scheme

Addressing the Challenges of Health Care Delivery System in Nigeria Through Aggressive Implementation of the National Health Insurance Scheme

 

Abstract

This study was on addressing the challenges of health care delivery system in Nigeria through aggressive implementation of the national health insurance scheme (NHIS). Three objectives were raised which included: To determine the challenges face healthcare delivery system in Nigeria, to investigate the quality of healthcare services in NHIS-accredited healthcare facilities by assessing adherence to medical standards, the availability of necessary equipment, and the competency of healthcare professionals and to examine the extent to which the NHIS provides financial protection to its enrolled members by assessing the reduction in out-of-pocket expenditures and its influence on the economic well-being of households..

The total population for the study is 75 selected staff of selected hospital in Delta state. The researcher used questionnaires as the instrument for the data collection. Descriptive Survey research design was adopted for this study. The data collected were presented in tables and analyzed using simple percentages and frequencies. The study concluded that the aggressive implementation of the NHIS offers a viable path toward a more equitable, accessible, and efficient healthcare system in Nigeria. With sustained efforts, collaboration among stakeholders, and a commitment to overcoming the challenges, Nigeria has the potential to transform its healthcare delivery system and improve the health and well-being of its citizens. The study highlights the importance of prioritizing and investing in a comprehensive healthcare reform agenda that places universal health coverage at its core.

 

Chapter one

Introduction

1.1Background of the study

Nigeria, the most populous country in Africa, faces numerous challenges in its healthcare delivery system. The nation struggles with issues such as inadequate healthcare infrastructure, limited access to quality healthcare services, and a high burden of preventable diseases. To address these challenges, the Nigerian government established the National Health Insurance Scheme (NHIS) in 1999. This study wants to investigate how aggressive implementation of the NHIS can significantly contribute to improving the healthcare delivery system in Nigeria.

One of the significant challenges in Nigeria’s healthcare system is the limited access to quality healthcare services. The NHIS aims to address this issue by providing a mechanism for citizens to access healthcare services at accredited healthcare facilities. According to the World Bank, as of 2020, less than 10% of the Nigerian population had health insurance coverage. However, the aggressive implementation of the NHIS can substantially increase this percentage, ensuring more Nigerians have access to healthcare services (World Bank, 2020).

The NHIS encourages healthcare providers to meet certain quality standards to maintain their accreditation. This incentive helps drive the quality of care provided in accredited facilities. By actively implementing and enforcing these standards, Nigeria can raise the overall quality of healthcare services available to its citizens (National Health Insurance Scheme, 2023).

The NHIS provides financial protection to enrolled members by covering a portion of their healthcare expenses. This is particularly crucial in Nigeria, where out-of-pocket expenditures for healthcare are high. By reducing the financial burden on individuals and families, the NHIS helps to ensure that healthcare services are accessible to all, regardless of their socioeconomic status (National Health Insurance Scheme, 2023).

The NHIS requires accredited healthcare facilities to meet certain infrastructure and equipment standards. This requirement can stimulate investments in healthcare infrastructure, leading to the establishment of more modern and well-equipped healthcare facilities across the country. By aggressively implementing the NHIS, Nigeria can encourage such investments, ultimately strengthening its healthcare infrastructure (National Health Insurance Scheme, 2023).

The NHIS covers a range of preventive healthcare services, including immunizations and health education. By promoting these services, the scheme can help reduce the burden of preventable diseases, which is a significant issue in Nigeria. Preventive care is not only cost-effective but also contributes to the overall health and well-being of the population (National Health Insurance Scheme, 2023).

Nigeria faces significant health disparities between different regions and socioeconomic groups. Aggressively implementing the NHIS can help reduce these disparities by ensuring that healthcare services are accessible to all citizens, regardless of their location or income level. This is essential for achieving health equity in the country (World Health Organization, 2020).

The challenges facing Nigeria’s healthcare delivery system are substantial, but the aggressive implementation of the National Health Insurance Scheme (NHIS) holds the potential to significantly address these issues. By expanding healthcare access, improving the quality of care, providing financial protection, strengthening healthcare infrastructure, promoting preventive services, and reducing health disparities, the NHIS can play a pivotal role in improving healthcare in Nigeria. As the government and stakeholders work together to enhance the NHIS, they can move closer to achieving a more efficient and equitable healthcare system in the country.

 

Statement of the problem

The healthcare delivery system in Nigeria is plagued by a multitude of challenges, which hinder its ability to provide equitable, accessible, and high-quality healthcare services to the population. Despite the establishment of the National Health Insurance Scheme (NHIS) in 1999, these challenges persist and continue to impact the health and well-being of Nigerians. This statement of the problem highlights the key issues that necessitate aggressive implementation of the NHIS to address the following areas:

Access to quality healthcare services in Nigeria remains significantly limited, particularly in rural and underserved areas. This lack of access is exacerbated by the high cost of medical care, leading to a substantial portion of the population being unable to receive necessary medical attention.

Quality of care in many healthcare facilities is subpar, leading to preventable morbidity and mortality. Lack of adherence to medical standards and guidelines, inadequate equipment and facilities, and a shortage of well-trained healthcare professionals contribute to this problem.

The healthcare system in Nigeria heavily relies on out-of-pocket payments, forcing individuals and families to bear a disproportionate financial burden for medical services. This places a considerable strain on households, often leading to catastrophic health expenditures and financial hardship.

The healthcare infrastructure in Nigeria is often outdated, under-resourced, and lacking in necessary medical equipment. The aggressive implementation of the NHIS is critical to stimulating investments in healthcare infrastructure, leading to better-equipped and more modern healthcare facilities across the country.

Nigeria faces a high burden of preventable diseases, such as malaria, tuberculosis, and vaccine-preventable illnesses. The lack of access to preventive services and insufficient health education exacerbate this issue, contributing to unnecessary suffering and mortality.

The disparities in healthcare access and outcomes between urban and rural areas, as well as between different socioeconomic groups, persist and contribute to health inequities in the country. These disparities result in unequal health outcomes, with the most vulnerable populations being the most adversely affected.

 

Objective of the study

The primary objective of this study is to comprehensively examine the impact of the aggressive implementation of the National Health Insurance Scheme (NHIS) on the healthcare delivery system in Nigeria. To achieve this overarching goal, the study will pursue the following specific objectives:

1. To determine the challenges face healthcare delivery system in Nigeria.
2. To investigate the quality of healthcare services in NHIS-accredited healthcare facilities by assessing adherence to medical standards, the availability of necessary equipment, and the competency of healthcare professionals.
3. To examine the extent to which the NHIS provides financial protection to its enrolled members by assessing the reduction in out-of-pocket expenditures and its influence on the economic well-being of households.

Research Questions

To guide the study on the aggressive implementation of the National Health Insurance Scheme (NHIS) in Nigeria and its impact on the healthcare delivery system, the following research questions are formulated:

1. What are challenges of healthcare delivery system in Nigeria?
2. To what extent has the NHIS improved the quality of healthcare services in accredited healthcare facilities, and what are the factors contributing to variations in quality?
3. What is the impact of the NHIS on reducing out-of-pocket expenditures for healthcare services, and how does this financial protection affect the economic well-being of households?

Research Hypotheses

The following research hypotheses are formulated

(H0): There are no challenges of healthcare delivery system in Nigeria.

(H1): There challenges of healthcare delivery system in Nigeria.

(H0): The NHIS has not led to a significant improvement in the quality of healthcare services in accredited healthcare facilities.

(H1): The NHIS has led to a significant improvement in the quality of healthcare services in accredited healthcare facilities.

(H0): The NHIS has not significantly reduced out-of-pocket expenditures for healthcare services, and it has had no significant impact on the economic well-being of households.

(H1): The NHIS has significantly reduced out-of-pocket expenditures for healthcare services, and it has had a significant positive impact on the economic well-being of households.

 

Significance of the study

The proposed study on the aggressive implementation of the National Health Insurance Scheme (NHIS) in Nigeria holds substantial significance for various stakeholders, including policymakers, healthcare professionals, researchers, and the general population, due to the following reasons:

1. Improved Healthcare Access: Understanding the impact of the NHIS on healthcare access in Nigeria is critical for policymakers and healthcare providers. The study will shed light on the extent to which the NHIS has expanded access to healthcare services, particularly for underserved populations, ultimately contributing to the goal of universal health coverage.
2. Enhanced Healthcare Quality: By evaluating the quality of healthcare services in NHIS-accredited facilities, the study can help identify areas where improvements are needed. This information can guide healthcare providers in enhancing the quality of care and adherence to medical standards.
3. Financial Protection: The study’s findings on the NHIS’s impact on financial protection will be valuable for policymakers and the government in their efforts to reduce the financial burden on households. It will provide insights into the scheme’s effectiveness in preventing catastrophic health expenditures.
4. Infrastructure Development: Assessing the NHIS’s influence on healthcare infrastructure and equipment is essential for healthcare investments. The study will provide data to encourage further investments in healthcare facilities and technology, potentially leading to a more robust healthcare infrastructure.
5. Preventive Healthcare: Understanding how the NHIS promotes preventive healthcare services can contribute to efforts to reduce the burden of preventable diseases. This knowledge can guide health education and immunization programs, ultimately leading to better public health outcomes.
6. Health Equity: The study’s analysis of the NHIS’s role in reducing health disparities can help in designing targeted interventions to achieve health equity. This is crucial for addressing the unequal distribution of healthcare resources and outcomes in Nigeria.
7. Informed Policy Decisions: The study’s policy recommendations will serve as a valuable resource for government agencies, policymakers, and stakeholders involved in the healthcare sector. It can guide the development of evidence-based policies to improve healthcare delivery in Nigeria.
8. Academic Research and Knowledge Base: This research will contribute to the existing body of knowledge on healthcare delivery, health insurance, and health systems in Nigeria. It can serve as a reference for future research, academic studies, and public discourse on healthcare policy in the country.
9. Societal Well-being: Ultimately, the significance of this study lies in its potential to positively impact the overall health and well-being of the Nigerian population. By providing insights and recommendations, the study can help create a healthcare system that is more accessible, of higher quality, and equitable, resulting in improved health outcomes and a better quality of life for Nigerians.

 

Scope of the study

The scope of the study covers addressing the challenges of health care delivery system in Nigeria through aggressive implementation of the national health insurance scheme (NHIS). The study will be limited to selected hospital in Delta state

Limitation of the study

When addressing the challenges of the healthcare delivery system in Nigeria through the aggressive implementation of the National Health Insurance Scheme (NHIS), it’s important to acknowledge the potential limitations of the study. Identifying these limitations can help ensure the research is conducted in a more comprehensive and accurate manner. Here are some possible limitations of such a study:

Data Availability and Quality: Data on the NHIS and its impact on healthcare delivery may be limited or of varying quality. Official statistics may not fully reflect the real-world situation, and there may be a lack of up-to-date data.

1. Regional Disparities: Nigeria is a diverse country with significant regional disparities. What works in one region may not work in another. The study may not fully capture the nuanced challenges and benefits of the NHIS across different regions.
2. Implementation Challenges: Aggressive implementation of the NHIS may face administrative, bureaucratic, and operational challenges. This could impact the effectiveness and efficiency of the program, but such challenges might not be fully addressed in the study.
3. Long-Term Effects: The NHIS may have long-term consequences that are difficult to capture in a short-term study. Understanding the sustainability of the scheme and its impact over a longer period is challenging.
4. Political and Policy Changes: Changes in government and healthcare policies can have a significant impact on the NHIS. The study may not consider these changes or their potential impact.
5. Sample Size and Representativeness: The study may have limitations related to the sample size and its representativeness. A small sample may not accurately reflect the diversity of the Nigerian population.

Definition of terms

1. National Health Insurance Scheme (NHIS): NHIS is a government-led healthcare program that provides financial risk protection and access to quality healthcare services for eligible individuals and families in a country. It typically involves mandatory or voluntary contributions and aims to improve healthcare affordability and accessibility.
2. Healthcare Delivery System: The healthcare delivery system encompasses all the organizations, institutions, professionals, resources, and processes involved in providing medical care and services to individuals and communities. It includes both public and private healthcare facilities and services.
3. Aggressive Implementation: Aggressive implementation refers to a proactive, determined, and swift execution of a particular policy, program, or strategy, often with a focus on achieving rapid and significant results or outcomes.
4. Challenges: Challenges in this context refer to the obstacles, issues, or problems that hinder the effectiveness, efficiency, or success of the healthcare system or a specific program such as the NHIS.
5. Socioeconomic Factors: Socioeconomic factors are the social and economic conditions that influence and shape the well-being of individuals and communities. These factors may include income, education, employment, and housing, among others.
6. Cultural and Belief Factors: Cultural and belief factors encompass the traditions, customs, religious beliefs, and values of a society or community, which can influence behaviors, attitudes, and decision-making related to healthcare and other aspects of life.
7. Infrastructure and Healthcare Resources: Infrastructure and healthcare resources refer to the physical and organizational assets necessary for the delivery of healthcare services. This includes hospitals, clinics, medical equipment, healthcare personnel, and information systems.

References

• Federal Republic of Nigeria. (2014). National Health Act 2014.
• National Primary Health Care Development Agency (NPHCDA). (2018). Primary Health Care Under One Roof (PHCUOR) Operationalization Framework.
• National Health Insurance Scheme (NHIS). (2017). NHIS Quality Assurance and Control Measures.
• National Health Insurance Scheme (NHIS). (2021). NHIS Benefit Packages for Various Programs. Onwujekwe, O., Onoka, C., Uzochukwu, B., & Okoli, C. (2017). Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria. Health Economics Review, 7(1), 44.
• World Health Organization. (2015). Nigeria health system assessment 2015. WHO.
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• Transparency International. (2020). Corruption Perceptions Index 2020.
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• Oyeyemi, A. S., Oyeyemi, A. Y., & Adegoke, B. O. (2019). Health management information system utilization in the health sector in Kaduna State, Nigeria. African Journal of Primary Healthcare & Family Medicine, 11(1), e1-e6.
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• Ejeliogu, E. U., Gwarzo, U. M. D., & Sadiq, H. A. (2021). Determinants of utilization of maternal and child health services in Nigeria: A scoping review. International Journal of Maternal and Child Health and AIDS, 10(2), 204-215.

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