The Evaluation Of The Effect Of National Health Insurance Scheme In Enhancing Health Care Delivery

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The Evaluation Of The Effect Of National Health Insurance Scheme In Enhancing Health Care Delivery


The project on the topic evaluation of the effect of natural health insurance scheme in enhancing health care delivery in Enugu metropolis was discussed chapter by chapters. First in the introduction was attempt of adopting a health insurance system in Enugu and also to look into starting a health insurance system in Nigeria. Which the future benefit is bright. The statement of the problem were looked into the failure to understand the significant contribution of effective and efficient national health insurance scheme in Enugu.

Further, some materials previously written on this topic were reviewed to come up with recent information concerning this project like in chapter four the researcher enumerated the following findings as concerned the work and went ahead to discuss those findings. Finally, the project work ended with conclusion and recommendation, where it was recommended that the percentage of the effect and efficient of national health care insurance scheme should increase to attract more good health.

Chapter One


1.8 Background of the Study

Health insurance is a social security system that guarantees the provision of needed health services to persons on the payment of taken contributions at regular intervals. The first attempt at adopting a health insurance system, Nigeria started in 1962 during the first republic. The federal government invited Dr. Halevi through the international labour organization (120) to look into starting a health insurance system in Lagos. Then minister for health Dr. Majekodunmi also presented the first bill to the parliament. When a committee was commissioned to study the national insurance (Oji, 2003).

The health population and indeed work force are indisputable tools for rapid socio-economic and sustainable development the world over. Despite thus indisputable fact, in Nigeria like most Africa countries, the provision of quality accessible and affordable health care remark a serious problem (WHO, 2007, Oba, 2008), thus is because the health sector is permeably face with cross shortage of personnel, inadequate and outdated medical equipment policy inconsistence and corruption.

Other factor that impede quality health care delivery IN Enugu include inability of the consume to pay for health services gender bias due to religious or cultural beliefs and inequality in the distribution of health care facilities between urban and rural areas. In 2007 for instance, world health organization (WHO) report on health care delivery ranked Nigeria 187 out of 191 countries than in 2005 only 48 and 35 percent of the children within the age of zero to one year old were fully immunized against tuberculosis and measles respectively between 1998 and 2005, 28 percent of the children with in the ages of 5 years who suffered from diarrhea received and equate treatment.

A social health insurance scheme involves contribution base on means and utilization based on need. A health insurance scheme has been define as an arrangement in which contribution are made by or behalf of employees or individual (members) to purchasing institution (a fund) which is responsible for purchasing coursed services from providers or behalf of the members of the scheme (Kutzin) 1997. It is the opinion of Nigeria government that the NHIS will probably provide effective health care services and help to improve accessibility to health care services and help to improve accessibility to health care services (Ibwaye 2007). But the assessment of the programme after four years of operation reveals less than 3% coverage (Ikpong: 2007), and these was as a result of poor implement of the scheme in Nigeria. This research will evaluate the effect of national health insurance in enhancing health care delivery in Enugu.

1.2 Statement of the Problem

The following are problems that prompted the research of this project work:

  1. Failure to understand the significant contribution of effective and efficient national insurance scheme in Enugu.
  2. Failure on the part of the Nigeria government to enhance easy accessibility of national health insurance scheme.
  3. Poor effective administration and management of the activities and operation of the national health insurance scheme in Enugu.
  4. Unawareness of the existence, roles, important benefits and workability of national health insurance scheme.

1.3 Objective of the Study

The following are the objectives of the research work:

  1. To find out the significant contributions of effective and efficient national insurance scheme in Nigeria.
  2. To find out whether the government enhance easy accessibility of the national insurance in Enugu.
  3. To examine whether there is any awareness of the existence, roles, important benefits and workability of the business activities of national insurance scheme in Enugu.
  4. To find out the problems facing effective and efficient administration and management of national insurance scheme in Enugu.

1.4 Research Hypotheses

For the successful completion of the study, the following research hypotheses were formulated by the researcher;

  1. H0: there are no significant contributions of effective and efficient national insurance scheme in Nigeria.
    H1: there are significant contributions of effective and efficient national insurance scheme in Nigeria.
  2. H02: Governments do not enhance easy accessibility of the national insurance in Enugu.
    H2: Governments enhance easy accessibility of the national insurance in Enugu.

1.5 Significance of the Study

This study will give a clear insight the evaluation of the effect of national health insurance scheme in enhancing health care delivery. The study will be beneficial to insurance company and the general public. The study will also serve as a reference to other researchers that will embark on this topic.

1.6 Scope and Limitation of the Study

The scope of the study covers the evaluation of the effect of national health insurance scheme in enhancing health care delivery. The researcher encounters some constrain which limited the scope of the study;

a) Availability of Research Material:

The research material available to the researcher is insufficient, thereby limiting the study

b) Time:

The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.

c) Organizational Privacy:

Limited Access to the selected auditing firm makes it difficult to get all the necessary and required information concerning the activities

1.7 Definition of the Study

National Health Insurance Scheme:

National Health Insurance Scheme refers to a health insurance program set up by the National government.


Health is the ability of a biological system to acquire, convert, allocate, distribute, and utilize energy with maximum efficiency


Intensify, increase, or further improve the quality, value, or extent

Health Care Delivery:

The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as

1.8 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows

  1. Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  2. Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  3. Chapter three deals on the research design and methodology adopted in the study.
  4. Chapter four concentrate on the data collection and analysis and presentation of finding.
  5. Chapter five gives summary, conclusion, and recommendations made of the study

Chapter Five

Summary Conclusion and Recommendation

5.1 Introduction

It is important to ascertain that the objective of this study was to evaluate of the effect of health insurance scheme on healthcare delivery. In the preceding chapter, the relevant data collected for this study were presented, critically analyzed and appropriate interpretation given. In this chapter, certain recommendations made which in the opinion of the researcher will be of benefits in addressing the challenges health insurance scheme on healthcare delivery system

5.2 Summary

Haven successfully completed the study it is pertinent to state that the level of enrolment into the HIS is still very poor which inevitably contributes to the poor health status of Nigerians and the dismal health indices recorded in our health institutions. The level of dissatisfaction in the scheme is also a cause for concern that requires immediate attention from both the HMO’s and the healthcare providers. Sources of dissatisfaction included poor registration services, poor referral system, delays in receiving required services and unavailability of required service. The non coverage by the insurance scheme of some of the services required by enrolees is a policy issue which can only be dealt with at the level of policy formulation. Suffice to note that some enrolees (44%) will not mind increasing their contributions into the scheme in as much as these services would be covered in the benefit package.

5.3 Conclusion

Though Kwara State has made attempt at developing State Strategic Health Development Plan under the auspices of WHO. The present KWSSHP seeks to streamline and empower the SMOH and LGA health departments to reposition their organizational and management systems to provide the strategic and tactical leadership and governance for health. The KWSSHDP adopted priority areas of the NSHDP and developed state specific intervention areas taken into consideration various high impact services. The resource requirement for health was looked into with respect to Human, Physical/Material and Financial resources for health. It is addressed to bridge the gap observed in the state health sector. The financial plan aspect of KWSSHDP seek to close the financial gap in the state with adequately costed activities for the year operational plan and critically assessed available funds which is government budgetary provision, while exploring financial projections from the other sources like donor agencies and private sector. Implementation of the KWSSHDP is characterized by an adequately scheduled work plan which was derived from high impact activities list to accelerate the attainment of MDGs 4, 5 and 6. While some activities are planned for a year period, some are planned continuously for the period of the plan. A number of the activities are to be periodically executed. The training plan which also follows similar trends with work plan would take into priority practical exposure as part of training package, so as to bridge the gap between training and translation of acquired skills into practice for better performance. The procurement plan seeks to improve the effectiveness of procurement unit and develop an all encompassing procurement policy.

5.4 Recommendation

Haven successfully completed the study; the following recommendations are put forward by the researcher;
Removal of all bottlenecks encountered in the registration process in order to fast track registration of new and existing employees into the scheme Making policy statements to enable enrolment of self employed individuals and the immediate.

Creating an avenue where unemployed individuals can also access healthcare services at little or no cost even when they are not making contributions. The government can bear the cost incurred by the unemployed especially for those officially registered in a government certified unemployment register.

Compulsory enrolment into the scheme should be enforced for all working Nigerians starting with those working in government organizations. This will improve our dismal health indices as most Nigerians will then have access to better healthcare services without the encumbrance of large out of pocket expenses.

The researcher recommends that employers who are not willing to enrol their employees should be prosecuted.
Health Maintenance Organizations and healthcare providers must realize that enrolees have the right to choose who their service providers are and can change to another when not satisfied with services rendered. Therefore, it is recommended that every provider strive to provide the best of services and the monitoring agencies should step up their monitoring antennae in order to curb the menace of dissatisfaction which is fast becoming common place in the scheme.

Several Nigerians are not fully enlightened in the components and structure of the NHIS. The researcher recommends a massive and far reaching enlightenment campaign to educate the populace on the scheme, the benefits there in and the rights of an enrollee

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