Page 80 - GHES-2-4

Global Health Economics and
Sustainability
NHIS: Acceptability and preferred benefit package

accessibility to health care for Nigerians. However, it are available, are accepted, and if people can afford to use
was not made mandatory at inception (Anderson & them when required (Uzochukwu et al., 2015). According
Adeniji, 2019; Okpani & Abimbola, 2015). Following the to the World Bank, the rise in the number of individuals
establishment of the National Health Insurance Authority living in extreme poverty has a close correlation with out-
(NHIA), the amendment under ACT 17 of the NHIA of-pocket payment of health-care expenses (Claeson et al.,
makes it mandatory for all Nigerian citizens and legal 2002). Thus, establishing a financial risk protection system
residents to be covered under the NHIS, with the scheme to prevent the approximately 90 million Nigerians who
administered by the Health Maintenance Organizations, already live in poverty from being forced into extreme
or registered third-party administrators (the Federal poverty due to the unaffordable health-care expenses
Government of Nigeria, 2022). There are different types of is essential (Erinoso et al., 2023). Health-care services
programs under the NHIS, namely Formal Sector Social consumer acceptance and satisfaction are important, but it
Health Insurance Program, Voluntary Contributors appears that the majority have not fully accepted the NHIS,
Social Health Insurance Program, Students of Tertiary with others still hesitant to take a stand, as they are all
Institutions Social Health Insurance Program, Informal suspicious of government motives, desires, and strategies,
Sector Social Health Insurance Program, Vulnerable especially when they realize that a monthly deduction from
Group Social Health Insurance Program, Physically their salaries will be made as their contribution into the
Challenged Persons Social Health Insurance Program, commonality pool to operate the scheme (Ahmed & Aliyu,
Prison Inmates Social Health Insurance Program, 2019). This may be one of the reasons why Rivers State is
Children Under Five (5) Social Health Insurance the last state in Nigeria to commence the state-run health
Program and Refugees, Victims of Human Trafficking, insurance scheme, namely the Rivers State Contributory
Internally Displaced Persons, and Immigrants Social Health Protection Program. This program enables the
Health Insurance Program (NHIS, 2020). state to access the basic health-care fund from the federal
The scheme commenced with the formal sector, where government.
most government employees (federal civil servants) serve, It is, however, worthy of note that previous researches
the organized private sector, and the armed forces. The have demonstrated that limited coverage throughout the
NHIS covers the principal and spouse with four children nation, low health-seeking behavior among Nigerians, and
under 18 years, providing access to primary health care numerous exclusions from the NHIS benefit package have
and referral for secondary or tertiary care. The public all contributed to the low utilization of the NHIS across the
sector employees are expected to contribute 1.75% of country (Ahmed & Aliyu, 2019; Anderson & Adeniji, 2019;
their salary while the employer contributes 3.25%. For the Latunji & Akinyemi, 2018). In Nigeria, the acceptance of
private sector, the employees are expected to contribute 5% the NHIS services varies from region to region and from
of their salary while the employer contributes 10% (NHIS, state to state. This underscores the necessity to periodically
2020; Eboh et al., 2016).
determine the baseline level of NHIS acceptance and the
Since its establishment, the NHIS has experienced a rise preferred benefit package among the employees in the
in coverage. In 2005, the enrollees were <150,000, but in formal sector, where most civil servants serve, to aid in
2014, the number had risen to about 5 million, which is the assessment and improvement of the health insurance
approximately 3% of the Nigerian population. However, as program. These data will also serve as an important source
of 2016, <5% of the Nigerian population had coverage, with for comparison in future research, especially concerning
higher coverage among those in the federal sector. This the civil servants in the state. Since a health insurance
leaves the majority of the population uninsured (Ahmed & scheme was previously not launched in the state, there is no
Aliyu, 2019; Erinoso et al., 2023). concrete information about the civil servants’ acceptance
Thus, out-of-pocket payments remain the primary and preferences for health insurance program.
mode of payment for health-care expenses. Such payments The findings of this study will serve as a guide for the
account for over 90% of personal health-care expenses, state government health insurance policy formulation,
placing a disproportionately heavy financial burden on implementation as well as evaluation concerning the
low-income earners, who end up paying more for the different potential health benefit packages available
expenses due to delays in seeking medical care (Ahmed & to the formal sector in the state. This study aims to
Aliyu, 2019). determine the level of acceptance and preferred benefit
A key factor in achieving universal health coverage package of the NHIS among civil servants in Rivers State
lies in how a nation finances its health-care system. This as well as the association between the acceptability of the
is because they determine whether health services exist, NHIS and the socioeconomic status of civil servants.

Volume 2 Issue 4 (2024) 2 https://doi.org/10.36922/ghes.2909