MANAGEMENT OF NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN THE PUBLIC SECTOR: ISSUES, PROBLEMS AND PROSPECTS

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MANAGEMENT OF NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN THE PUBLIC SECTOR: ISSUES, PROBLEMS AND PROSPECTS

TABLE OF CONTENTS

                                                                                                                                       Pages

Title page                                                                              ii

Certification                                                                                            iii

Dedication                                                                              iv

Acknowledgement                                                                v

Abstract                                                                                                   vi

Table of contents                                                                               vii

CHAPTER ONE:  INTRODUCTION

Background of the study                                                                   1

Statement of problem                                                          3

Objectives of the study                                                         4

Research questions                                                                  4

Hypotheses                                                 5

Significance of study                                                                       5

Scope and limitations of the study                               6

References                                                                                                                8

CHAPTER TWO:  LITERATURE REVIEW

2.1       An overview of Healthcare Service Delivery in Nigeria 9

2.2       Objectives of National Healthcare Service Delivery  12

2.3       Imperatives of free Healthcare Services     13

2.4       Financing of Healthcare Services in Nigeria 14

2.5       National Health Insurance Scheme         18

2.6       National health Insurance Scheme Programmes           21

2.7       Excluded Services                                    23

2.8       Management of National Health Insurance Scheme          24

2.8.1   Organisation structure                                    24

2.8.2   National Health Insurance Council             25

2.8.3   Health Maintenance Organizations                26

2.8.4   Health Service Providers                        28

2.8.5   Funding of NHIS                                          29

2.8.6   Procedures and Coverage                                 30

2.9      Benefits of NHIS                                                      32

2.10    Evaluation of NHIS                               37

References                                                         53

CHAPTER THREE:  RESEARCH METHODOLOGY

3.1       Research Design                                                            56

3.2       Location of Study                                                    56

3.3       Sources of Data                                                                  57

3.4       Population                                                                                         57

3.5       Sample Size Determination and Sampling Technique            58

3.6       Instrument of data collection                         59

3.7       Data collection procedure                      59

3.8       Analytical Technique                          60

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS

4.1       Presentation of Data                              62

4.2       Analysis of Data                        62

4.3       Test of hypotheses                                   78

CHAPTER FIVE:  SUMMARY, CONCLUSION AND FINDINGS

5.1 Summary of Findings                                                        83

5.2 Conclusion                                                                                           85

5.3 Recommendations                                                                             86

      Bibliography                                                                                                                   88

      Appendix                                                                              91

      Questionnaire                                    92

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

          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 epidemic and endemic disease and efficient healthcare service delivery. Mfon (2005:21) expresses that a nation with an effective healthcare system is a wealthy nation and is development –oriented in the social context. In Nigeria, however, the health situation is a manifestation of malnutrition and low life expectancy for the majority, high incidence of epidemics and endemic diseases as well as inefficient healthcare service delivery.

          It is in recognition of the significance of good health system that the Nigerian government has been consistent in its quest for an efficient healthcare delivery to be perpetually established in Nigeria.

          It has been emphasized that no meaningful development can take place in the country if the greater proportion of the populace have no access to effective healthcare services and live in squalor and disease. The rapidly growing population therefore need adequate healthcare services for effective physical and intelligence development. Lambo (2006:12) observes that there was a sharp contradiction in the nations healthcare services in the periods of 1960s/70s and 1980s/20002. in the former, healthcare delivery was an effective term of cost and coverage with the government catering adequately for the cost of health services. But since the 1980s, the financing of health services has risen so much that the government has found it difficult to bear the burden in much the sand way was it did in the earlier periods.

          Ugbanmadu (2003:24) observes that health services have become a matter of concern to the government given the dividing finances of the government which began in the 1980s.

          Thus, when the Obsanjo administration came into being on May, 29 1999 the nation’s health sector was near comatose. Hospitals were in bad shape. Community and inter-sectoral collaboration was minimal. Ugbaja (2007:19) remarks that resources devoted to this vital social services were insufficient. Worst still, there was outright inadequacy of drugs and other consumables in most government health facilities. There was also paucity of qualified manpower in the government hospitals. The available ones were not motivated while facilities and equipment were poorly maintained.

          Other lapses of the past included inadequate manpower development to meet modern trend and improper monitoring of  services rendered to the public among others. From inception, therefore, it was clear to Obasanjo’s administration that the sector needed an urgent surgical operation.

          Consequently, Oduenyi (2002:42) notes that in October 2003, federal Government organized a national conference on Alternative Healthcare financing in Nigeria. Participants were drawn from private and public health institutions and agencies through out Nigeria. They examined the inadequacies of health service, the casual factors as well as remedies for inadequate health services financing in Nigeria. Interalia, the conference ended with a call for improved health services financing.

          Thus, in line with economic reforms in the country, health sector reform gained momentum with adequate health  service financing as its cardinal objective, this resulted in the inception of the National  Health Insurance Scheme (NHIS) on June 6, 2003 by  ex-president Olusegun Obasanjo. The scheme had earlier been launched by the then Head Of State, late General Sani Abacha on 15th  October,1997.

STATEMENT OF PROBLEM

The  National Health Insurance Scheme (NHIS) is faced with several problem which hampered its effective implementation in the health sector.

First, there are administrative problems which consist in the delay of remittances from government  and government establishments to the National Health Insurance Scheme (Council) and from the NHIS to Health Maintenance Organizations (HMOS) down to Health service providers.

Second, there are inadequacies of health facilities and medical personnel to cover the nation sufficiently under the scheme. This is due to limited number of  HMOs and HSPs registered in the scheme.

Thirdly, many Health Service providers are either withdraw from the scheme or refusing to accept new enrollees.

Again, inadequate Logistic support facilities from the government and donor-agencies limit the coverage of the scheme so far to the public sector thus leaving the larger private sector out of the scheme.

          Finally, there is public skeptism and apathy towards insurance in general and widespread ignorance about social health insurance. All these problems militate against effective implementation of the NHIS in Nigeria.

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