Abstract

health Insurance Scheme (HIS) is a health care scheme established by the Kwara state Government of Nigeria for better healthcare delivery to its populace. The objective of this study was to determine the proportion of Nigerian adults enrolled in the scheme, their satisfaction with the quality and availability of services within the scheme and the factors responsible for the dismal health indices in the country despite the scheme


AN EVALUATION OF THE EFFECTIVENESS OF HEALTH INSURANCE SCHEME ON HEALTHCARE DELIVERY SYSTEM IN KWARA STATE.
SPROJECT NG DECEMBER 21, 2018 EDIT
Abstract

health Insurance Scheme (HIS) is a health care scheme established by the Kwara state Government of Nigeria for better healthcare delivery to its populace. The objective of this study was to determine the proportion of Nigerian adults enrolled in the scheme, their satisfaction with the quality and availability of services within the scheme and the factors responsible for the dismal health indices in the country despite the scheme



















CHAPTER ONE

INTRODUCTION

Background of the study
Today we find ourselves at a crossroads where the burden of disease is greater than ever before, especially in low-income countries. Moreover, multi- and bi-lateral donors have increasingly limited resources. The number of individuals living with HIV/AIDS alone (only one of the many health burdens faced today) is over 33 million and the funds necessary to provide treatment for those individuals well-exceed foreign assistance budgets, not to mention local budgets. The centrality of health to State development and poverty reduction is self evident, as improving health status and increasing life expectancy contribute to long term economic development. The legitimacy of any State health system depends on how best it serves the interest of the poorest and most vulnerable people, for which improvements in their health status is geared towards the realization of poverty reduction goals. In the Nigerian context, current reviews show that the country is presently not on course to achieving the health-related Millennium Development Goals (MDGs) by 2020. This poses a major developmental challenge, which will impede and undermine development and economic growth.

We cannot afford anymore to squander valuable resources on programs for which we do not have positive evidence of their impact. Development policymakers across the world are beginning to understand this and impact evaluation research has become a major tool to inform the policy dialogue. Such evaluations lead to crucial decisions to scale-up programs, alter them or replace them with alternative mechanisms. Currently, our knowledge is limited with respect to the impact of health insurance in Africa due in part to the fact that health insurance has historically been limited to the wealthy elite in this part of the world. Findings from other regions are mixed but mostly positive (Giedion and Diaz, 2008). To the best of our knowledge, this impact evaluation is the first rigorous impact study of subsidized low-cost private health insurance and clinic-upgrade programs in Africa, funded by the Health Insurance Fund (HIF) and implemented by the Pharm Access Foundation (Pharm Access). The impact evaluation represents the culmination of a multiyear operational research program on these initiatives led by the Amsterdam Institute for International Development (AIID) and the Amsterdam Institute for Global Health and Development (AIGHD) in several countries. The report evaluates the short-term impact of Hygeia Community Health Care (HCHC) on treatment communities (communities receiving the intervention) in Central Kwara State, Nigeria.

The indispensability of good healthcare system in national development underlies the government’s commitment to providing adequate healthcare services since Nigeria attained political independence in 1960 (Ugbaja, 2003:6). in terms of cost and delivery, the Nigerian healthcare system was adjudged effective and efficient in the periods of the 1960s and up to the late 1970s, by the early 1980s shortage of health facilities including drugs and personnel had set in resulting in rising cost of healthcare services. The situation seemed to favour private sector health institutions which were enjoying relative boost in patronage as the general poor state public healthcare system continued deteriorating. According to Abacha (1985:3), the public hospitals had become (consulting clinics” Given the rapid population growth rate, what the nation needed was a commensurate increasing level of care services. But the decreasing finance of the government oil left the government with no other choice than reducing budgetary allocation to the health sector (Ozuh, 2004:30) prior to the government almost solely financed health services in public health institutions. But by the turn of the 1980s, it had become joint responsibility of the government and the citizens (Ughamadu, 2003:23). In other words both the government and the citizens shared the costs of healthcare services in public health institutions with the greater burden weighing heavily on the government. Subsidization of healthcare services was paramount in healthcare budgetary allocation.

STATEMENT OF THE PROBLEM
Three years after its inception, the NHIS has not effectively taken off and operated as initially conceived. This is as a result of challenges facing the scheme. First, the scheme is still limited to the public sector and has not been extended to the private sector due to apparent lack of political will and commitment. The scheme suffers from restricted coverage. Second, there is continuous delay in remittance from government establishment to the NHIS council, which also delays remittance to Health Maintenance Organization (HMOS) Providers (HSPS). This makes the scheme to suffer from ineffective financing. Third, the scheme lacks adequate facilities and personnel to cover the nation sufficiently. This arises from the limited number of the Health Maintenance Organization (HMOS) and Health Service Providers (HSPS) registered to operate in the scheme. Besides, most of the HSPs lack adequate medical equipments and dedicated personnel to implement the scheme. Fourth, many of the Health Service Providers (HSPs) are withdrawing from the scheme and some functional ones are refusing to register new clients or public servants.

OBJECTIVE OF THE STUDY

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