Community-based health insurance programmes and the National Health Insurance Scheme of Nigeria: challenges to uptake and integration.

Isaac Ao Odeyemi

doi:10.1186/1475-9276-13-20

Abstract

BackgroundNigeria has included a regulated community-based health insurance (CBHI) model within its National Health Insurance Scheme (NHIS). Uptake to date has been disappointing, however. The aim of this study is to review the present status of CBHI in SSA in general to highlight the issues that affect its successful integration within the NHIS of Nigeria and more widely in developing countries.MethodsA literature survey using PubMed and EconLit was carried out to identify and review studies that report factors affecting implementation of CBHI in SSA with a focus on Nigeria.ResultsCBHI schemes with a variety of designs have been introduced across SSA but with generally disappointing results so far. Two exceptions are Ghana and Rwanda, both of which have introduced schemes with effective government control and support coupled with intensive implementation programmes. Poor support for CBHI is repeatedly linked elsewhere with failure to engage and account for the ‘real world’ needs of beneficiaries, lack of clear legislative and regulatory frameworks, inadequate financial support, and unrealistic enrolment requirements. Nigeria’s CBHI-type schemes for the informal sectors of its NHIS have been set up under an appropriate legislative framework, but work is needed to eliminate regressive financing, to involve scheme members in the setting up and management of programmes, to inform and educate more effectively, to eliminate lack of confidence in the schemes, and to address inequity in provision. Targeted subsidies should also be considered.ConclusionsDisappointing uptake of CBHI-type NHIS elements in Nigeria can be addressed through closer integration of informal and formal programmes under the NHIS umbrella, with increasing involvement of beneficiaries in scheme design and management, improved communication and education, and targeted financial assistance.

Highlights

Nigeria has included a regulated community-based health insurance (CBHI) model within its National Health Insurance Scheme (NHIS)
After sorting and obtaining full copies of the papers selected, we examined each publication for information on factors relevant to the success or otherwise of CBHI schemes, with particular emphasis on observations recurring across different countries
Other data were sourced from official sources such as the Nigerian government’s NHIS website [9] and the World Health Organization (WHO) [20], and from a review of the situation pertaining to Nigeria by a key opinion leader [9]

Summary

Introduction

Nigeria has included a regulated community-based health insurance (CBHI) model within its National Health Insurance Scheme (NHIS). The World Health Organization (WHO) views medical fees as a significant obstacle to healthcare coverage and utilisation, and has stated that the only way to reduce reliance on direct payments is for governments to encourage the risk-pooling prepayment approach [1]. In this environment, community-based health insurance (CBHI) has emerged as an alternative to user fees. Some CBHI schemes operating in sub-Saharan Africa (SSA), including that of Nigeria, have been hampered by low enrolment rates, limited resource mobilisation and poor sustainability [4]

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