Volume 93, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Health insurance coverage of the informal sector is a challenge in Nigeria. This study assessed the methods of payment for health care and awareness about the National Health Insurance Scheme (NHIS) among members of selected households in a rural area in the southwest of Nigeria. Using a multistage sampling technique, a semi-structured, pretested interviewer-administered questionnaire was used to collect data from 345 households. The majority of the people still pay for health care by out-of-pocket (OOP) method. Awareness about the NHIS in Nigeria was poor, but attitude to it was encouraging; and from the responses obtained, the people implied that they were willing to enroll in the scheme if the opportunity is offered. However, lack of trust in government social policies, religious belief, and poverty were some of the factors that might impede the implementation and expansion of the NHIS in the informal sector. Stakeholders should promote socioculturally appropriate awareness program about the NHIS and its benefits. Factors that might present challenges to the scheme should be adequately addressed by the government and other stakeholders associated with prepayment schemes in Nigeria.


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  1. Ezeoke OP, Onwujekwe OE, Uzochukwu BS, , 2012. Towards universal coverage: examining costs of illness, payment, and coping strategies to different population groups in southeast Nigeria. Am J Trop Med Hyg 86: 5257.[Crossref] [Google Scholar]
  2. Humphreys G, , 2010. Nigerian farmers rejoice in pilot insurance plan. Bull World Health Organ 88: 329330.[Crossref] [Google Scholar]
  3. Onoka CA, Onwujekwe OE, Uzochukwu BS, Ezumah NN, , 2013. Promoting universal financial protection: constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria. Health Res Policy Syst 11: 20.[Crossref] [Google Scholar]
  4. World Bank, 2013. World Bank Data, World Development Indicators (WDI). Available at: http://data.worldbank.org/country/nigeria. Accessed January 29, 2013.
  5. Carapinha JL, Ross-Degnan D, Desta AT, Wagner AK, , 2011. Health insurance systems in five sub-Saharan African countries: medicine benefits and data for decision making. Health Policy 99: 193202.[Crossref] [Google Scholar]
  6. Mathauer I, Schmidt JO, Wenyaa M, , 2008. Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand. Int J Health Plann Manage 23: 5168.[Crossref] [Google Scholar]
  7. Van Damme W, Van Leemput L, Por I, Hardeman W, Meessen B, , 2004. Out-of-pocket health expenditure and debt in poor households: evidence from Cambodia. Trop Med Int Health 9: 273280.[Crossref] [Google Scholar]
  8. Jütting J, , 2001. Health Insurance for the Rural Poor? Community Financing Scheme in Senegal to Protect Against Illness. Available at: http://www.oecd.org/dev/2510517.pdf. Accessed August 13, 2013. [Google Scholar]
  9. Sudha VM, , 2006. Health Security for Rural Poor: Study of Community Based Health Insurance. Available at: http://mpra.ub.uni-muenchen.de/1649/. Accessed August 13, 2013. [Google Scholar]
  10. Adeniyi AA, Onajole AT, , 2010. The National Health Insurance Scheme (NHIS): a survey of knowledge and opinions of Nigerian dentists' in Lagos. Afr J Med Med Sci 39: 2935. [Google Scholar]
  11. Dienye PO, Brisibe SF, Eke R, , 2011. Sources of healthcare financing among surgical patients in a rural Niger Delta practice in Nigeria. Rural Remote Health 11: 1577. [Google Scholar]
  12. Katibi IA, Akande AA, Akande TM, , 2003. Awareness and attitude of medical practitioners in Ilorin towards the National Health Insurance Scheme. Sahel Med J 6: 3.[Crossref] [Google Scholar]
  13. Olugbenga-Bello AI, Adebimpe WO, , 2010. Knowledge and attitude of civil servants in Osun state, southwestern Nigeria towards the national health insurance. Niger J Clin Pract 13: 421426. [Google Scholar]
  14. Bhat R, Jain N, , 2006. Factors Affecting the Demand for Insurance in a Micro Health Insurance Scheme. Working paper no. 2006-07-02. Ahmedabad, India: Indian Institute of Management. [Google Scholar]
  15. Nyagero J, Gakure R, Keraka M, , 2012. Health insurance education strategies for increasing the insured among older population—a quasi experimental study in rural Kenya. Pan Afr Med J 12: 9. [Google Scholar]
  16. Ezeaka CV, Ugwu RO, Mukhtar-Yola M, Ekure EN, Olusanya BO, , 2014. Pattern and predictors of maternal care-seeking practices for severe neonatal jaundice in Nigeria: a multi-centre survey. BMC Health Serv Res 14: 192.[Crossref] [Google Scholar]
  17. Fawole OI, Adeoye IA, , 2015. Women's status within the household as a determinant of maternal health care use in Nigeria. Afr Health Sci 15: 217225.[Crossref] [Google Scholar]
  18. Fapohunda BM, Orobaton NG, , 2013. When women deliver with no one present in Nigeria: who, what, where and so what? PLoS One 8: e69569.[Crossref] [Google Scholar]
  19. Ahmed S, Delaney K, Villalba-Diebold P, Aliyu G, Constantine N, Ememabelem M, Vertefeuille J, Blattner W, Nasidi A, Charurat M, , 2013. HIV counseling and testing and access-to-care needs of populations most-at-risk for HIV in Nigeria. AIDS Care 25: 8594.[Crossref] [Google Scholar]
  20. National Health Insurance Scheme, 2006. Annual Report. Abuja, Nigeria: Federal Government of Nigeria. [Google Scholar]
  21. Federal Ministry of Health, 2010. National Strategic Health Development Plan (NSHDP) 2010–2015. Abuja, Nigeria: Federal Ministry of Health. [Google Scholar]
  22. National Health Insurance Scheme, 2012. Operational Guidelines, Revised October 2012. Abuja, Nigeria: National Health Insurance Scheme.
  23. Agba AMO, Ushie EM, Osuchukwu NC, , 2010. National Health Insurance Scheme (NHIS) and employees' access to healthcare services in Cross River State, Nigeria. Global J Hum Soc Sci 7: 10. [Google Scholar]
  24. Onwujekwe O, Okereke E, Onoka C, Uzochukwu B, Kirigia J, Petu A, , 2010. Willingness to pay for community-based health insurance in Nigeria: do economic status and place of residence matter? Health Policy Plan 25: 155161.[Crossref] [Google Scholar]
  25. Onwujekwe O, Uzochukwu B, , 2005. Socio-economic and geographic differentials in costs and payment strategies for primary healthcare services in southeast Nigeria. Health Policy 71: 383397.[Crossref] [Google Scholar]
  26. Ministry of Local Government and Chieftaincy Matters of Oyo State, 2014. Detailed Information of the 33 Local Governments in Brief. Available at: http://www.oyostate.gov.ng/ministries-departments-and-agencies/local-government-and-chieftaincy-matters/detailed-information-of-the-33-local-governments-in-brief/. Accessed December 12, 2014. [Google Scholar]
  27. Oyo State Government of Nigeria, 2014. The Pacesetter State. Available at: https://en.wikipedia.org/wiki/Oyo_State. Accessed June 13, 2015. [Google Scholar]
  28. National Bureau of Statistics, 2012. Nigerian Poverty Profile Report, 2010. Abuja, Nigeria: National Bureau of Statistics. [Google Scholar]
  29. World Health Organization, 2013. World Health Statistics, Nigeria 2012. Geneva, Switzerland: World Health Organization. [Google Scholar]
  30. Donfouet HP, Makaudze E, Mahieu PA, Malin E, , 2011. The determinants of the willingness-to-pay for community-based prepayment scheme in rural Cameroon. Int J Health Care Finance Econ 11: 209220.[Crossref] [Google Scholar]
  31. Evans DB, Carrin G, Evans TG, , 2005. The challenge of private insurance for public good. Bull World Health Organ 83: 1. [Google Scholar]
  32. Gopalan SS, Durairaj V, , 2012. Addressing women's non-maternal healthcare financing in developing countries: what can we learn from the experiences of rural Indian women? PLoS One 7: 8.[Crossref] [Google Scholar]
  33. Russell S, , 1996. Ability to pay for health care: concepts and evidence. Health Policy Plan 11: 219237.[Crossref] [Google Scholar]
  34. Chuma J, Mulupi S, McIntyre D, , 2013. Providing financial protection and funding health service benefits for the informal sector: evidence from sub-Saharan Africa. London, UK: KEMRI—Wellcome Trust Research Programme, University of Cape Town.
  35. World Health Organization, 2010. World Health Report—Health Systems Financing: The Path to Universal Coverage. Executive Summary. Geneva, Switzerland: World Health Organization. [Google Scholar]
  36. Witter S, Garshong B, , 2009. Something old or something new? Social health insurance in Ghana. BMC Int Health Hum Rights 9: 20.[Crossref] [Google Scholar]
  37. Odeyemi IA, Nixon J, , 2013. Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis. Int J Equity Health 12: 9.[Crossref] [Google Scholar]
  38. Kirigia JM, Sambo LG, Nganda B, Mwabu GM, Chatora R, Mwase T, , 2005. Determinants of health insurance ownership among South African women. BMC Health Serv Res 5: 17.[Crossref] [Google Scholar]
  39. Xu K, James C, Carrin G, Muchiri S, , 2006. An Empirical Model of Access to Health Care, Health Care Expenditure and Impoverishment in Kenya: Learning from Past Reforms and Lessons for the Future. Discussion paper no. 3-2006. Geneva, Switzerland: HSF/WHO. [Google Scholar]
  40. Kingdon J, , 2010. Agenda, Alternatives and Public Policies, updated 2nd edition. Harlow, England: Longman Classics. [Google Scholar]
  41. Peterson MA, , 2011. It was a different time: Obama and the unique opportunity for health care reform. J Health Polit Policy Law 36: 429436.[Crossref] [Google Scholar]
  42. Steinmo S, Watts J, , 1995. It's the institutions, stupid! Why comprehensive national health insurance always fails in America. J Health Polit Policy Law 20: 329372.[Crossref] [Google Scholar]
  43. World Health Organization, 2006. Appreciating Assets: The Contribution of Religion to Universal Access in Africa. The World Health Report, African Religious Health Assets Program (ARHAP). Geneva, Switzerland: World Health Organization. [Google Scholar]
  44. Kimani JK, Ettarh R, Kyobutungi C, Mberu B, Muindi K, , 2012. Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey. BMC Health Serv Res 12: 66.[Crossref] [Google Scholar]
  45. Saksena P, Antunes AF, Xu K, Musango L, Carrin G, , 2011. Mutual health insurance in Rwanda: evidence on access to care and financial risk protection. Health Policy 99: 203209.[Crossref] [Google Scholar]
  46. Schmidt JO, Mayindo JK, Kalk A, , 2006. Thresholds for health insurance in Rwanda: who should pay how much? Trop Med Int Health 11: 13271333.[Crossref] [Google Scholar]

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  • Received : 20 Apr 2014
  • Accepted : 11 May 2015
  • Published online : 02 Sep 2015

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