Evaluation of Enrollees’ Perspectives on the Operations of the National Health Insurance Scheme in Nigeria

Background: The National Health Insurance Scheme (NHIS) was established in 2005 to act as an alternative source of funding for health care services but marred with operational problems. Objective: The study examined the mode of operation of the NHIS and assessed its adequacy to achieve set objectives in the face of contending factors from the point of view of enrollees. Methods: A descriptive cross-sectional survey of 300 enrollees in three tertiary health facilities in Southwestern Nigeria was undertaken between August and October, 2019. Participants were selected using a combination of quota and simple random sampling methods. Primary data were obtained using semi-structured questionnaires and focus group discussions. Frequency, percentages, weighted means and relative importance indices were used to analyse data at p<0.05 level of significance. Results: Response rate for both focus groups and questionnaires was 100 %. Mean age of respondents was 43.11 years while that of focus groups discussants was 40.81 years. Enrollees understood the objectives of the NHIS and its components especially its focus on improving service efficiency (85%). However, they posit that the mode of operations was inadequate to accomplish those goals. Factors identified as responsible for this include capacity limitations in terms of infrastructure (89%), human resources (84%), and financial resources (66%); corruption (65%) as well as poor responsiveness by service providers (44%).Conclusion: Enrollees in the NHIS in Nigeria understand the goals of the scheme even though more enlightenment is needed to drive home the philosophy. The mode of operations is inadequate to achieve the objectives of the scheme. Reforms are needed to address inadequacies in infrastructure, capacities and management of services.