Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration

International Journal for Equity in Health

Isaac AO Odeyemi¹ 

[1]Health Economics & Outcomes Research, Astellas Pharma Europe Ltd, 2000 Hillswood Drive, Chertsey KT16 0RS, UK

关键词: Nigeria;    Sub-Saharan Africa;    NHIS;    National Health Insurance Scheme;    Healthcare;    CBHI;    Community-Based Health Insurance;   

Others  :  803915
DOI  :  10.1186/1475-9276-13-20

 received in 2013-07-17, accepted in 2014-02-07,  发布年份 2014

【 摘 要 】

Background

Nigeria 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.

Methods

A 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.

Results

CBHI 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.

Conclusions

Disappointing 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.

【 授权许可】

   
2014 Odeyemi; licensee BioMed Central Ltd.

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