Predictors of Enrolment in the National Health Insurance Scheme Among Women of Reproductive Age in Nigeria.

Bolaji Samson Aregbeshola,Samina Mohsin Khan

doi:10.15171/ijhpm.2018.68

Bolaji Samson Aregbeshola, Samina Mohsin Khan

Open Access

https://doi.org/10.15171/ijhpm.2018.68

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Abstract

Background: Despite the implementation of the National Health Insurance Scheme (NHIS) since 2005 in Nigeria, the level of health insurance coverage remains low. The study aims to examine the predictors of enrolment in the NHIS among women of reproductive age in Nigeria. Methods: Secondary data from the 2013 Nigeria Demographic and Health Survey (NDHS) were utilized to examine factors influencing enrolment in the NHIS among women of reproductive age (n=38 948) in Nigeria. Demographic and socio-economic characteristics of women were determined using univariate, bivariate and multivariate analyses. Data analysis was performed using STATA version 12 software. Results: We found that 97.9% of women were not covered by health insurance. Multivariate analysis indicated that factors such as age, education, geo-political zone, socio-economic status (SES), and employment status were significant predictors of enrolment in the NHIS among women of reproductive age. Conclusion: This study concludes that health insurance coverage among women of reproductive age in Nigeria is very low. Additionally, demographic and socio-economic factors were associated with enrolment in the NHIS among women. Therefore, policy-makers need to establish a tax-based health financing mechanism targeted at women who are young, uneducated, from poorest households, unemployed and working in the informal sector of the economy. Extending health insurance coverage to women from poor households and those who work in the informal sector through a tax-financed non-contributory health insurance scheme would accelerate progress towards universal health coverage (UHC).

Highlights

Expanding health insurance coverage to people in the informal sector of the economy is a major challenge in most low- and middle-income countries (LMICs)
Voluntary contributory health insurance scheme for women from poor households and those working in the informal sector may not be feasible in expanding health insurance coverage due to financial constraint and difficulty in collecting contributions among these groups
Implications for the public There are concerns about the effectiveness of the National Health Insurance Scheme (NHIS) to expand health insurance coverage to women from poor households and those working in the informal sector

Summary

Introduction

Expanding health insurance coverage to people in the informal sector of the economy is a major challenge in most low- and middle-income countries (LMICs). Evidence suggests that gender plays an important role in NHIS enrolment.[28] Women face different health risk and difficulties in accessing healthcare services.[34] They bear a greater burden of disease and have limited access to resources.[29,34] The ILO revealed that a higher percentage of women are in informal employment than men.[1] It is against this background that the study aims to examine factors associated with enrolment in the NHIS among women of reproductive age in Nigeria in order to inform policy decisionmaking towards addressing the problem of low enrolment in the NHIS.

Methods

Results

Discussion

Conclusion