Abstract

This research was supported by UNN TETFUND Committee through TETFUND Institution Based Research Fund. Abstract Background: Financial risk protection for healthcare is deficient in Enugu state, Southeast Nigeria and the worst affected are the rural dwellers and the poorest, thus creating both socioeconomic and geographic inequity in access and use of services. The study aimed at eliciting the level of awareness and use of pre-payment mechanisms, and more importantly, determining the economic and political factors that facilitate or constrain achievement of Universal Health Coverage in Enugu state, Southeast Nigeria. Methods: Study was conducted in two purposively chosen urban and rural local government areas(LGA) of Enugu state with mixed method study design. Cross-sectional household questionnaire survey was conducted on 802 sample size from the two LGAs and 12 key informants participated in In-depth interviews (IDIs). The quantitative data was analysed with STATA using descriptive statistics while the qualitative IDI data was organized into nodes and sub-nodes using Nvivo: political and economic factors, corruption, communication/Awareness, capacity development / Infrastructure, policy development, leadership and referral system. Later, findings were thematically analysed. Results: The survey results showed that 84% of the study sample have secondary school education and 83% are engaged in employment or petty business. About 56% are aware of prepayment mechanism for healthcare bills but only 10% of them have used prepayment mechanisms. Out of pocket payment (85%) is the main source of payment at health facilities. Major political constraining factors to UHC revealed by the IDI include lack of political will backed with financial commitment from the political leaders, lack of legislative framework for UHC, lack of trust on the political leaders/government by the citizenry and inactive civil society organizations. Also, the poor fiscal space for health and the poverty level in the populace are big threats to sustainable UHC in Enugu state. Other economic challenges include corruption, poor health capacity development and poorly paid healthcare workers leading to poor quality of health care delivery. There is need for comprehensive health system development in the state to accommodate UHC. Conclusions: Establishment of sustainable UHC in Enugu state faces considerable political and economic challenges. There is need for increased government budgetary allocation for UHC to ensure coverage for the poor and vulnerable members. The lack of legislative framework for UHC could be resolved by legislative arm of the government. The government should invest in health system development to improve the quality of health care services to compliment the FRP component of UHC. Keywords : Universal Health Coverage, Health Insurance, Financial Risk Protection DOI : 10.7176/DCS/9-4-07 Publication date : April 30 th 2019

Highlights

  • Two quotations that aptly summarize the challenges facing the achievement of Universal Health Coverage (UHC) in Enugu State come from two key informants: “What discouraged me personally was when I found out that the government wasn’t ready to do anything ... yes, we are interested in universal health coverage, but we have not made any law in Enugu state to take care of anything

  • In this study we set out with the understanding of UHC to be synonymous with financial risk protection (FRP) and provision of good quality health care service to all the people

  • It is evident from the literature that contributory social insurance scheme that is universal, progressive and mandatory with adequate subsidy provisions for the poor and vulnerable groups in the society are the prerequisites for sustainable UHC in Enugu state and Nigerian in general

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Summary

Introduction

The study aimed at eliciting the level of awareness and use of pre-payment mechanisms, and more importantly, determining the economic and political factors that facilitate or constrain achievement of Universal Health Coverage in Enugu state, Southeast Nigeria. 1.0 Introduction / Background: Universal Health Coverage (UHC) has been defined as having “access to all needed quality health services without financial hardship” (Saksena, Hsu and Evans, 2014; WHO, 2010). The financial risk protection (FRP) component of UHC targets the protection of healthcare service users from the effects of catastrophic expenditures and impoverishment of Out of Pocket (OOP) payments (Saksena, Hsu and Evans, 2014; McIntyre and Mills, 2012; Giedion, Alfonso and Díaz, 2013; Arin and Hongoro, 2013). “Social health insurances aim to enable as many people as possible to enjoy good health by organising the funding of health care through payment according to means and providing access to health services according to need” (Doetinchem, Schramm and Schmidt, 2006, p. 32)

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