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The Role of Trust in the Pattern of Enrollment to a Social Health Insurance Scheme and Distribution of Healthcare Facilities in Ibadan, Southwest Nigeria

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  • 1 Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria;
  • | 2 Department of Public Health & Family Medicine, Division of Public Health Medicine, University of Cape Town, Cape Town, South Africa;
  • | 3 Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;
  • | 4 Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom;
  • | 5 Department of Public Health & Family Medicine, Division of Public Health Medicine, University of Cape Town, Cape Town, South Africa

ABSTRACT.

The National Health Insurance Scheme (NHIS) of Nigeria established in the year 2005 aims to minimize the inequity of access to quality healthcare services in Nigeria. As of the year 2017, enrollment in NHIS-accredited facilities in the southwest region of Nigeria was significantly clustered, with more than three-quarters of NHIS enrollees registered with only 10% of the available NHIS-accredited facilities in the six states of the region. This study explored the factors associated with the skewed distribution of enrollees across facilities and the influence of stakeholders. This is a descriptive, qualitative, case study design among stakeholders of the NHIS in Ibadan, Oyo State, Southwest, Nigeria. In-depth interviews were conducted between March and June, 2019, with all selected individual stakeholders as listed earlier. Data analysis was done using an inductive thematic approach. Across the board, there was a low level of trust in government and government policies among healthcare providers and enrollees. Few healthcare providers were willing to render services under the scheme at inception. The majority of the enrollees were compelled to register with the few available healthcare providers. Among the enrollees, a few personally chose healthcare facilities and providers that were perceived to render better quality services to receive care. Priority should be given to building trust among stakeholders in the NHIS as this would facilitate cooperation and better working relationship, and reposition the scheme for better performance.

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Author Notes

Address correspondence to David Ayobami Adewole, Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria, and Department of Public Health & Family Medicine, Division of Public Health Medicine, University of Cape Town, Cape Town, South Africa. E-mail: adwdav001@myuct.ac.za

Disclosure: Ethical approval to conduct study was sought and obtained at the Oyo State Ethical Review Committee, Ref. No. AD 13/479/596. Likewise, the research was approved by the Ethics Committee of the University of Cape Town, South Africa, HREC REF 536/2018. The design of the work conforms to standards currently applied in Nigeria. Study participants’ consent was sought and obtained. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors’ addresses: David A. Adewole, Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria, and Department of Public Health & Family Medicine, Division of Public Health Medicine, University of Cape Town, Cape Town, South Africa, E-mail: adwdav001@myuct.ac.za. Steve Reid, Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, E-mail: steve.reid@uct.ac.za. Tolu Oni, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom, and Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa, E-mail: tolu.oni@mrc-epid.com.ac.uk.

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