Page 81 - GHES-2-4

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

2. Data and methods were on leave or unwillingly to participate or were away for
official assignments were excluded from the study.
2.1. Study design and setting
This study was a descriptive cross-sectional study of civil 2.4. Research tool
servants in Rivers State, Nigeria, which is one of the states A semi-structured questionnaire comprising of four sections
of the Niger Delta region with three senatorial districts and was used. Section A questions on sociodemographics such
23 Local Government Areas with Port Harcourt City as the as age and sex. Section B questions on acceptability of and
state capital (Rivers State MOH, 2010; Uriah et al., 2015). perception about the NHIS. On acceptability, respondents
The population is estimated to be over 7 million (Nigeria: were asked if the NHIS is acceptable to them as a payment
Administrative Division (States and Local Government strategy for health-care services. Questions on perception
Areas) – Population Statistics, Charts and Map, 2024). similar to that used by Onwujekwe et al., 2010 were asked
Rivers State has a rich cultural heritage with various ethnic on a Likert-type scale, e.g., (1) From either your experience
groups. It has two seaports and the second-largest economy or understanding, how would you rate the potential
in Nigeria and is now home to several multinational oil financial risk protection by NHIS against the cost of illness?
companies. Before the discovery of oil, agriculture and (2) What do you think is the potential level of household
fishing were the major economic activities in the state. access to affordable health care covered by NHIS? (3) How
At the time of data collection, Rivers State Civil Service would you rate the potential of NHIS to improve household
had 26 ministries domiciled at the state secretariat. These health consumption patterns by ensuring that health-care
professional civil servants, led by the head of the service, costs are reduced? (4) How would you rate the potential of
carry out the state government policies concerning health, NHIS to improve the quality of services provided by health-
social service delivery, and infrastructural growth and care givers? (5) How would you rate the potential of NHIS
development. Each ministry is headed by a commissioner to ensure constant availability of drugs at health facilities
assisted by the administrative head the permanent in the state? The response could be chosen from a range
secretary (Wikipedia, 2020). of options: “none,” “low,” “medium,” and “high.” Section
C includes questions on preferred health benefits package
2.2. Variables of interest on a Likert scale (Anderson & Adeniji, 2019), for example,
In this study, the variables studied were socioeconomic respondents were asked to rate the type of package they
status which is the independent variable, whereas preferred, with response options such as “most preferable,”
acceptability of NHIS and preferred health benefits “more preferable,” “medium preferable,” “less preferable,”
package are the outcome variables. and “least preferable.” The respondents were asked to rate
the following packages:
2.3. Sample size and sampling 1. Type I: Package covering everything (including all

A minimum sample size of 351 was derived using the inpatient and outpatient services and emergencies)
formula for a descriptive cross-sectional study (Jerkel 2. Type II: Package covering only basic disease control
et al., 2007). The data of a big proportion of the sample, services, like the prevention and treatment of common
at 72.8%, were obtained from a study carried out in North illnesses such as malaria, typhoid, and diarrhea.
Central Nigeria (Doku, 2012). A 5% margin of error at 3. Type III: Package covering only outpatient services:
a 95% confidence level was used and adjusted for a 10% (a) outpatient care including necessary consumables;
non-response rate and approximated to the nearest whole (b) essential drugs and essential diagnostic tests;
number. (c) maternity care for up to four live births;
(d) preventive care such as immunization, health
Nine ministries at the secretariat were randomly education, family planning, antenatal, and postnatal
selected using the total list of the 26 ministries as the care; and (e) consultation with specialists such as
sampling frame, thereafter a proportion-to-size allocation physicians, pediatricians, obstetricians, gynecologists,
based on the total number of staff in the selected ministries and general surgeons
was carried out to arrive at the number of respondents per 4. Type IV: Package covering only inpatient services
ministry. At each ministry, a systematic random sampling allowing for hospital care in a standard ward limited
using the list of staff was carried out; respondents who were to a cumulative 45 days per year
randomly selected but unavailable were replaced with those 5. Type V: Package covering only emergencies, such as
respondents on the ground till the sample size was obtained. emergency obstetric care, accidents, and traumas and
Only respondents who have worked for at least medical emergencies such as diabetic coma and stroke
12 months before the study were included. Those who heart attack.

Volume 2 Issue 4 (2024) 3 https://doi.org/10.36922/ghes.2909