KNOWLEDGE AWARENESS
AND BENEFITS OF NATIONAL HEALTH INSURANCE SCHEME AMONG CIVIL SERVANT IN UYO LGA
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO THE STUDY
Ever since Emperor Otto Von Bismarck of Germany
enacted the mandatory legislation on the “sickness funds” for working Germans
in 1883, different models of health insurance have continued to evolve
worldwide albeit with the same general insurance principles. In the developed
world, insurance in one form or the other is a veritable and sustainable tool
for financing healthcare. The National Health Insurance (NHIS) was launched in
Nigerian on October 15, 1997 and was passed into law in May 1999. The original
scheme has been modified to include healthcare for less privileged persons in
the country (FMH, 1998).
According to the World Health Organization (WHO) in
2005, Nigeria was ranked 197th out of 2000 nations; life expectancy
was put at 48 years for male and 50 years for female while healthy life
expectancy (HALE) for both sexes was put at 42 years. Nigeria accounts for 10%
of global maternal mortality with 59,000 women dying annually from pregnancy
and child birth; only 39% are delivered by skilled health professionals. In
order to provide equitable distribution of health, the NHIS was introduced in
Nigeria. The need for the establishment of the scheme was informed by the
general poor state of the nation’s healthcare services, excessive dependence
and pressure on the government’s provision of health facilities, dwindling
funding of health care in the face of rising cost, poor integration of private
health facilities in the nation’s healthcare delivery system and overwhelming
dependence on out – of – pocket expenses to purchase health.
Like any other insurance scheme, the premium for
the NHIS is the amount charged by the insurance compared with the promise to
pay for any eventual “covered medical treatment” for the designated “coverage”.
Consequently health insurance makes it possible to substitute a small but
certain cost for a larger but uncertain loss (chain) under an arrangement in
which the healthy majority compensate for the risks and costs of the
unfortunate ill minority. The NHIS currently represents 15% of one’s basic
salary. The employer is to pay 10% while the employee contributes 5% of his/her
basic salary to enjoy healthcare benefits. The contribution made by the insured
person entitles his/her spouse and four children under the age of 18 to full
health benefits (FMH 2005).
NHIS was designed to provide minimum economic
security for workers with regard to unfavorable losses resulting from accidental injury, sickness,
old age, unemployment and premature
death of family wage earner. NHIS is made compulsory because the government
based on past experiences predicted that some citizens cannot engage in the
scheme and the government also has the duty to protect the general welfare of
all citizens (Ibiwoye and Adedeke, 2007). It is also the government’s belief
that NHIS will help to break the vicious cycle of poverty in the country. It is
also a form of social support for workers (Jutting, 2003). There is lack of
health care coverage and little equity. Access to healthcare is limited and
most Nigerians are unable to pay for health services and health facilities are
far from being equitably distributed. All these contributed to the limitation
in health services (Samin and Awe, 2009). The available health services are
very expensive and the common man cannot afford it; only the privileged few can
get access to good health. This study aims at assessing the level of knowledge,
awareness and benefits of NHIS to the civil servants in Uyo LGA.
1.2 STATEMENT OF THE PROBLEM
Insurance is a veritable tool for
healthcare financing, it has been used by most advanced countries in its various
forms to fund healthcare. It is only recently being applied by poorer
developing nations to address the glaring problem of inadequate healthcare provision,
which was hitherto financed exclusively from public taxation. The health sector
can be subdivided into two main categories, healthcare infrastructure and
healthcare financing. Health funding relates directly to all production and financial
activities and resources expended on goods and services consumed by or provided
to the human population for the purpose of improving health.
Awareness and interest towards
government policies and programs can be aroused by individual attitude and
behaviour. Whenever there are negative perception and attitude and knowledge
towards these policies and programs, such policies and programs are bound to fail.
Awareness of these government programs and activities makes the governed to
have positive attitude and perception towards these programs, thus, improving
their participation and responsiveness to these programs. The National Health
Insurance Scheme (NHIS) was introduced in Nigeria with the promulgation of degree
No. 35 of 1999.5 with the broad objective of ensuring that every Nigerian has
access to good health care services at affordable costs. Participants are
expected to pay capitation fees to licensed Health Maintenance Organizations
(HMOs), which would allow the subscriber to have access to registered health
care providers. In this degree, Federal Executive Council approved National
Health
Insurance Council (NHIC) as an
omnibus regulator of the entire NHIS, which perhaps will correspond to the
institution/corporate body. Also National Health Insurance Fund (NHIF) was
established to manage deductions from public sector employees and employers
while HMO would receive contributions from their organized private sector
counterparts. These study seek to determine the level of knowledge, awareness
and benefits of NHIS among civil servants in Uyo LGA.
1.3 OBJECTIVES OF THE STUDY
The
following are the objectives of this study:
1. To
examine the level of knowledge and awareness of NHIS among civil servants in
Uyo LGA.
2. To
identify the benefits of NHIS among the civil servants in Uyo LGA.
3. To
determine the factors limiting the successful implementation of NHIS in Uyo
LGA.
1.4 RESEARCH QUESTIONS
1. What
is the level of knowledge and awareness of NHIS among civil servants in Uyo
LGA?
2. What
are the benefits of NHIS among the civil servants in Uyo LGA?
3. What
are the factors limiting the successful implementation of NHIS in Uyo LGA?
1.6 SIGNIFICANCE OF THE STUDY
The
following are the significance of this study:
1. Given the inefficiencies experienced in public hospitals,
it was expected that the populace would readily embrace the scheme. For some
reason this does not appear to be the reality. Outcome of this study will
increase the knowledge, awareness of NHIS in Uyo LGA by making the civil
servants understand the benefitsd of the scheme.
2. This research will also serve as a
resource base to other scholars and researchers interested in carrying out
further research in this field subsequently, if applied will go to an extent to
provide new explanation to the topic
1.7 SCOPE/LIMITATIONS OF THE STUDY
This
study will cover all the objectives of NHIS and the benefits with a view of
increasing the knowledge and awareness of the scheme.
LIMITATION OF STUDY
Financial constraint– Insufficient fund tends to impede the
efficiency of the researcher in sourcing for the relevant materials, literature
or information and in the process of data collection (internet, questionnaire
and interview).
Time constraint– The researcher will simultaneously engage in this
study with other academic work. This consequently will cut down on the time
devoted for the research work.
REFERENCES
Federal
Ministry of Health Abuja FMH (1998). The National Health Policy and strategy to
Achieve Health for all. FMH, Abuja.
FMH (2005).
Operational Guideline of National Health Insurance Scheme. FMH Abuja.
Jutting J
(2003). Health Insurance for the poor – Determinants of participation in
Community Based Health Insurance Scheme in Rural Areas, Elsevier Ltd Paris
Ibiwoye A,
Adeleke AA (2007). The Impact of Health Insurance on Healthcare provision in Developing
countries. Ghananian J. Development Stud. 4 (21) 49-58
Sanusi RA, Awe
AT (2009). An assessment of Awareness level of National Health Insurance Scheme
consumers in Oyo state Nigeria. The Medwell J. 4 (2) 143-148.