Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria

Health Research Policy and Systems

Nkoli N Ezumah²  Benjamin S Uzochukwu¹  Obinna E Onwujekwe³  Chima A Onoka¹ 

[1] Department of Community Medicine, College of Medicine, University of Nigeria, Enugu PMB 01129, Enugu, Nigeria;Department of Sociology/Anthropology, University of Nigeria, Nsukka Campus 410001, Enugu state, Nigeria;Department of Health Administration and Management, University of Nigeria, Enugu Campus 400001, Enugu state, Nigeria

关键词: Universal coverage;    Social health insurance;    Nigeria;    Health financing;    Case study;   

Others  :  809769
DOI  :  10.1186/1478-4505-11-20

 received in 2012-12-05, accepted in 2013-05-14,  发布年份 2013

【 摘 要 】

Background

The National Health Insurance Scheme (NHIS) in Nigeria was launched in 2005 as part of efforts by the federal government to achieve universal coverage using financial risk protection mechanisms. However, only 4% of the population, and mainly federal government employees, are currently covered by health insurance and this is primarily through the Formal Sector Social Health Insurance Programme (FSSHIP) of the NHIS. This study aimed to understand why different state (sub-national) governments decided whether or not to adopt the FSSHIP for their employees.

Methods

This study used a comparative case study approach. Data were collected through document reviews and 48 in-depth interviews with policy makers, programme managers, health providers, and civil servant leaders.

Results

Although the programme’s benefits seemed acceptable to state policy makers and the intended beneficiaries (employees), the feasibility of employer contributions, concerns about transparency in the NHIS and the role of states in the FSSHIP, the roles of policy champions such as state governors and resistance by employees to making contributions, all influenced the decision of state governments on adoption. Overall, the power of state governments over state-level health reforms, attributed to the prevailing system of government that allows states to deliberate on certain national-level policies, enhanced by the NHIS legislation that made adoption voluntary, enabled states to adopt or not to adopt the program.

Conclusions

The study demonstrates and supports observations that even when the content of a programme is generally acceptable, context, actor roles, and the wider implications of programme design on actor interests can explain decision on policy adoption. Policy implementers involved in scaling-up the NHIS programme need to consider the prevailing contextual factors, and effectively engage policy champions to overcome known challenges in order to encourage adoption by sub-national governments. Policy makers and implementers in countries scaling-up health insurance coverage should, early enough, develop strategies to overcome political challenges inherent in the path to scaling-up, to avoid delay or stunting of the process. They should also consider the potential pitfalls of reforms that first focus on civil servants, especially when the use of public funds potentially compromises coverage for other citizens.

【 授权许可】

   
2013 Onoka et al.; licensee BioMed Central Ltd.

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