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ABSTRACT
The study examined Implementing National Health Insurance scheme in the private sector: Challenges and Prospect. The main objective of the study is to examine the challenges of implementing National health Insurance scheme in Nigeria. the specific objectives are to discuss the objectives and perceived benefits of the specific health care services available in the scheme, to evaluate the influence of the NHIS on the health status of the private sector workers, to examine the challenges of implementing NHIS in the private sector, to find solutions to the problems of implementing NHIS in the private sector, to make informed recommendations for the improvement of the scheme. The population of this research work comprises of some selected firms and insurance companies in Port Harcourt metropolis which include, First Bank PLC, Agip Oil Company and Zenith NICON Nigeria plc Port Harcourt. the sample technique adopted is judgmental, thus, (30) insurance practitioners were selected from the companies operating in Port Harcourt, Rivers State and forty five(45) staff of First Bank and Agip company in Rivers State were selected, totaling seventy-five, (75) representing the sample size for the study and this forms the respondents for this study. the findings revealed that the key challenges for Nigeria’s health sector is to achieve the targets of the millennium development goals (MDGs), but it’s attainment is contingent upon the resolution of the challenges listed in the study. Based on the findings of the study summary, conclusion and recommendations were made that More intensive public intensive awareness programmes should be created to enlighten the people and relevant groups on the positive values of the scheme, It should be noted that pay-roll contributions by employers and employees are not the only way possible to fund the provision of health for the people. People’s health care can also be insured through special tax contributions, the scheme should be expanded to ensure that basic health needs of all citizens, irrespective of their social class and status are met.
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Healthy population and indeed work force are indispensable tools for rapid socio-economic and sustainable development the world over. Despite this indisputable fact, in Nigeria like most African countries, the provision of quality, accessible and affordable healthcare remains a serious problem (WHO, 2007a; Oba, 2008; Omoruan, Bamidele & Philips, 2009). This is because the health sector is perennially faced with gross shortage of personnel (WHO, 2007a), inadequate and outdated medical equipment (Yohesor, 2004; Johnson & Stoskopf, 2009), poor funding (WHO, 2007a&b), policies inconsistence (Omoruan, Bamidele & Philips, 2009) and corruption (Oba, 2008). Evidence shows that, only 4.6 percent of both public and private Gross Domestic Product (GDP) in 2004 was committed to the sector (WHO, 2007a, b&c). Other factors that impede quality health care delivery in Nigeria include inability of the consumer to pay for healthcare services (Sanusi & Awe, 2009), gender bias due to religious or culture beliefs (NCBI, 2009) and inequality in the distribution of healthcare facilities between urban and rural areas (Omoruan, Bamidele & Philips, 2009). Sequel to the aforementioned, the country is continually ranked low in healthcare delivery by international organizations. In 2000 for instance, WHO report on healthcare delivery ranked Nigeria 187 out of 191 countries (Wikipedia, 2009); eight years later, Human Development Report 2007/2008, ranked the country 158 out of 177. In 2005 only 48 and 35 percents of the children within the ages of zero-to-one year old were fully immunized against tuberculosis and measles respectively. Between 1998 and 2005, 28 percent of the children within the ages of 5 years who suffered from diarrhea received adequate treatment. Between 1997 and 2005 only 35 percent of births in Nigeria were attended by skilled health personnel. Furthermore, between 2000 and 2004, only 28 percent of Nigerians in every 100,000 persons had access to physicians. While the situation in the health sector persists, Nigeria continually loses her professional to other countries. It was reported in 1986 that more than 1,500 health professionals left Nigeria to other countries. In 1996, UNDP report revealed that 21,000 medical personnel were practicing in the United States of America and UK, while there was gross shortage of these personnel in the Nigerian health sector (Akingbade, 2006). The health situation in the country shows that only 39 percent in 1990 and 44 percent of Nigerians in 2004 have access to improved sanitation. In 1990/92 and 2002/04, 13 percent and 9 percent of Nigerians were undernourished respectively (UNDP, 2008). HIV prevalence in Nigeria within the ages of 15 to 49 years was 3.9 percent in 2005 (UNAIS, 2006). In an attempt to address the situation in the private sector, and to provide universal access to quality health care service in the country, various health policies by successive administration were made including the establishment of primary health care centres, general and tertiary hospitals. The perennial health problem informed the decision of Gen. Abdulsalami Abubakar on May 10, 1999, to sign into law the National Health Insurance Scheme (NHIS) Decree Number 35 (NHIS Decree No. 35 of 1999); with the aim of providing universal access to quality healthcare to all Nigerians. NHIS became operational after it was officially launched by the Federal Government in 2005 (Kannegiesser, 2009). More than four years of NHIS existence in Nigeria, opinion is polarized among Nigerians on the efficacy of the scheme in addressing the health problem in the country, because of disheartening reports in the continual health situation. For instance, World Bank (2008) survey on the scheme shows that only one million people in Nigeria or 0.8 percent of the population are covered by NHIS, while many persons have to pay for medical care out of their pockets or do without healthcare. The report further reveals that many low-income persons especially in the private sector would not benefit from NHIS for at least another 10 years. The purpose of this study therefore, is to examine the challenges and prospect of implementing national health insurance scheme in the private sector.
1.2 STATEMENT OF PROBLEMS
Despite this indisputable fact, in Nigeria like most African countries, the provision of quality, accessible and affordable healthcare remains a serious problem. This is because the health sector is perennially faced with gross shortage of personnel inadequate and outdated medical equipment, poor funding, policies inconsistence and corruption. Evidence shows that, only 4.6 percent of both public and private Gross Domestic Product (GDP) in 2004 was committed to the sector. Other factors that impede the implementation of NHIS in the private sector of Nigeria include inability of the workers to pay for healthcare services, religious or cultural beliefs and inequality in the distribution of healthcare facilities between urban and rural areas. Sequel to the aforementioned, the country is continually ranked low in healthcare delivery by international organizations.
1.3 OBJECTIVE OF THE STUDY
The main objective of the study is to examine the challenges and prospect of implementing national health insurance scheme in the private sector. The specific objectives are:
- To discuss the objectives and perceived benefits of the specific health care services available in the scheme.
- To evaluate the influence of the NHIS on the health status of the private sector workers.
- To examine the challenges of implementing NHIS in the private sector
- To find solutions to the problems of implementing NHIS in the private sector.
- To make informed recommendations for the improvement of the scheme.
1.4 RESEARCH QUESTIONS
- What are objectives and perceived benefits of the specific health care services available in the scheme?
- What is the extent to which NHIS has influenced the health status of the private sector workers?
- What are the challenges of implementing NHIS in the private sector?
- What are the solutions to the problems of implementing NHIS in the private sector?
1.5 RESEARCH HYPOTHESIS
HO: There are problems of implementing NHIS in the private sector of Nigeria.
HI: There is solution to the problems of implementing NHIS in the private sector of Nigeria.
1.6 SCOPE OF THE STUDY
This is deliberately on the challenges and prospect of Implementing National Health Insurance Scheme in the Private Sector. The study concerned on Nigeria but due to the vast geographical nature of the country, the study is conducted with the respect of some selected private firms in Rivers State comprissing First Bank PLC, Agip Oil Company and Zenith NICON Nigeria plc Port Harcourt.
1.7 SIGNIFICANCE OF THE STUDY
The study is expected to make recommendations to the government measures of implementing NHIS in the private sector.
The study will also help policy makers to ascertain the need for carrying out effective national health insurance scheme in Nigeria.
The opinions of this study will also open up future vents for young practitioners /scholars in the academic field in topical area under investigation and finally, this study will also be a useful guide and information to other students that will carry out their studies in the future.
1.8 DEFINITION OF TERMS
NHIS: The National Health Insurance Scheme is a form of National health insurance established by the Government of Ghana, with a goal to provide equitable access and financial coverage for basic health care services to Ghanaian citizens.
Private sector: The part of the national economy that is not under direct government control.
Insurance: A practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium.
Life assurance: It is a contract between an insurance policy holder and an insurer or assurer, where the insurer promises to pay a designated beneficiary a sum of money (the benefit) in exchange for a premium, upon the death of an insured person (often the policy holder).