Abstract
BackgroundNigeria and Ghana have recently introduced a National Health Insurance Scheme (NHIS) with the aim of moving towards universal health care using more equitable financing mechanisms. This study compares health and economic indicators, describes the structure of each country’s NHIS within the wider healthcare system, and analyses impacts on equity in financing and access to health care.MethodsThe World Bank and other sources were used to provide comparative health and economic data. Pubmed, Embase and EconLit were searched to locate studies providing descriptions of each NHIS and empirical evidence regarding equity in financing and access to health care. A diagrammatical representation of revenue-raising, pooling, purchasing and provision was produced in order to analyse the two countries’ systems.ResultsOver the period 2000–2010, Ghana maintained a marked advantage in life expectancy, infant mortality, under-5 year mortality, and has a lower burden of major diseases. Health care expenditure is about 5% of GDP in both countries but public expenditure in 2010 was 38% of total expenditure in Nigeria and 60% in Ghana. Financing and access are less equitable in Nigeria as, inter alia, private out-of-pocket expenditure has fallen from 80% to 66% of total spending in Ghana since the introduction of its NHIS but has remained at over 90% in Nigeria; NHIS membership in Nigeria and Ghana is approximately 3.5% and 65%, respectively; Nigeria offers a variable benefits package depending on membership category while Ghana has uniform benefits across all beneficiaries. Both countries exhibit improvements in equity but there is a pro-rich and pro-urban bias in membership.ConclusionsMajor health indicators are more favourable in Ghana and overall equity in financing and access are weaker in Nigeria. Nigeria is taking steps to expand NHIS membership and has potential to expand its public spending to achieve greater equity. However, heavy burdens of poverty, disease and remote settings make this a substantial challenge. Ghana’s relative success has to be tempered by the high number of exemptions through taxation and the threat of moral hazard. The results and methods are anticipated to be informative for policy makers and researchers in both countries and other developing countries more widely.
Highlights
In the countries of Sub-Saharan Africa, health care has evolved along a variety of different lines, which has led to systems today that exhibit a great deal of fragmentation and complexity [1]
61.1% had a fair knowledge of National Health Insurance Scheme (NHIS); 70.4% said NHIS will succeed if properly implemented; 76.6% believed NHIS will improve access to oral health services; 71.4% improve affordability, 68.3% improve availability of services. 74.4% said NHIS oral health care unacceptable
The majority of the dentists involved in this study had some knowledge of the NHIS and were generally positively disposed towards the scheme and viewed it as a good idea
Summary
In the countries of Sub-Saharan Africa, health care has evolved along a variety of different lines, which has led to systems today that exhibit a great deal of fragmentation and complexity [1]. The evolution of the National Health Insurance Scheme (NHIS) in Nigeria dates back to the post-independence era of 1962 [5]. Additional pressures that led to the introduction of the NHIS included: (1) the general poor state of the nation’s health care services, (2) the excessive dependence and pressure on governmentprovided health facilities, (3) dwindling funding of health care in the face of rising costs, and (4) poor integration of private health facilities in the nation’s health care delivery system [5]. Its principal aim is to secure ‘universal coverage and access to adequate and affordable healthcare in order to improve the health status of Nigerians, especially for those participating in the various programmes/products of the Scheme’ [5]. Nigeria and Ghana have recently introduced a National Health Insurance Scheme (NHIS) with the aim of moving towards universal health care using more equitable financing mechanisms. This study compares health and economic indicators, describes the structure of each country’s NHIS within the wider healthcare system, and analyses impacts on equity in financing and access to health care
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