ABSTRACT

This research work is aimed at evaluating the challenges and prospects of Nigerian Health Insurance Scheme. The study takes a look at the developmental issues in the history of National Health Insurance Scheme, the act setting up the scheme and its provisions. It looked at the management of the scheme, coverage and it is impact on the Nigeria health sector and Nigerians.

The research methodology used was interview and questionnaire which was administered to selected number of staff of National Health Insurance Scheme Enugu Zone, 2 health maintenance Organizations which are Expartcare Health International Limited and Healthcare International Limited Zonal office in Enugu and 3 health providers which are Ntasiobi Ndinafufu Specialist Hospital, Kenechukwu Hospital and Dental School Medical Centre all located in Enugu. In addition, the following were reviewed health reports, textbooks, National Health Insurance Scheme act of 1999 and published research on heath insurance in Nigeria. In addition, various statistical tools were used and Yomane’s Formula was used in calculating the samples size while Chi-square was used to test the hypotheses.

The study revealed that Nigerians saw the scheme as a welcome development which has helped to reduce cost of healthcare for beneficiaries but yet vast majority of Nigerians are not covered. The study also showed that healthcare providers are dissatisfied with the way the scheme is being implemented due to lack of organizational capacity.

Finally, recommendations were made for the sustainability of the scheme in Nigeria.

CHAPTER ONE

INTRODUCTION

1.1  BACKGROUND OF THE STUDY

A popular adage says that a healthy person is a wealthy person. Mfon (2005:21) expresses that a nation with an effective healthy care system is a wealthy nation and is development oriented in the social context. One of the basic needs of the people of any nation is good health. This incorporates physical fitness, adequate nutrition and food security, high life expectancy, absence of adequate and endemic disease and efficient health care service delivery. In Nigeria, however, the healthy situation is a manifestation of malnutrition, low life expectancy of the majority, high incidence of epidemic and endemic disease as well as inefficiency healthcare service delivery.

It has been emphasis that no meaningful development can take place in the country if the greater proportion of the population have no access to effective health care services and live in squat or and disease.

According to Omoruan, Bemidelle & Philips (2009:2) every government in Nigeria holds the view that a healthy population is essential for rapid socio-economic development of the country hence healthcare is on the concurrent list in the Nigerian constitution and its allocation comes next to education and defense in the national budget. Despite the large population, social services including health car services are inadequate coupled with several challenges facing the system. Various reforms programmes have been put forward and government has expressed it determination to pursue a bold reform of the system.

Thus, in May 1999 the government created the National Health Insurance Scheme (NHIS) by enacting into law Decree No. 35 on 10th May 1999, (now Act 35 of 1999) the scheme encompasses government employee, the organized private sector and the informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates.Thus, when Obasanjo administration came into being on May, 29 1999, the nation’s health sector was near comatose. Hospitals were in bad shape community an inter-sectoral collaboration was minimal (Adiekwe, 2009:2). Ugbaja (2007:19) remarks that resources devoted to this vital social services were insufficient. Worst still, there was out right, inadequacy of drugs and other consumables in most government health facilities. There was also paucity of qualified manpower in the government hospitals. The available motivated while facilities and equipment were poorly maintained.

Other lapses of the past include inadequate manpower development to meet modern trend and improper monitoring of services rendered t the public among others.

The National Health Insurance Scheme initiative was kept alive by Chief Olusegun Obasanjo the successor of Abubakar as a democratic president by further giving more legislative powers to the shame in 2004 with positive amendments to the original 1999 legislation. Implementation was however delayed till June 6th, 2005 (NHIS, 2005).

1.2  STATEMENT OF PROBLEMS

Organizational capacity in the management of an insurance based healthcare service is lacking at all levels of operation – health….