Knowledge And Perception Of The Federal Civil Servants Towards Health Insurance Scheme
National Health Insurance Scheme (NHIS) is a system of healthcare financing introduced by Federal Government of Nigeria to help reduce the risks and minimize the costs of healthcare. Since its inception, only the Formal Sector Social Health Insurance Programme (FSSHIP) has comprehensively taken off. This study investigated the knowledge and perception of Federal Civil Servants in Abuja Municipal Area Council (AMAC), Federal Capital Territory (FCT). A sample size of 200 Civil Servants were selected. The instrument for data collection was a researcher – designed 133 item questionnaire. Data were analysed using descriptive statistics such as frequencies, percentages, mean and standard deviation.
1.1 Background to the Study
Health system is designed to improve the standard of health care of the population. Improved funding and management of health systems lead to social stability. Population’s coverage is a clear indicator of the performance of the health system. The policy of National Health Insurance Scheme (NHIS) aims at increasing coverage of the Nigerian population. Health insurance as a health care financing mechanism has become a sought-after approach to the problem of financing healthcare all over the world. The current concern with financing, and the specific interest in health insurance is often the result of parallel trend; the recognition of basic healthcare for all citizens as a fundamental human right on the one hand, and the difficulties faced by governments in developing and maintaining resources to provide health care through general taxation revenue on the other (Mgbe & Kelvin, 2014). World Health Organization (WHO) has been giving tremendous support and cooperation to nations that pursue their citizen’s welfare through health insurance. They further noted that, nations equally are channeling large chunk of their budget to the attainment of good health for their people. Health insurance can be categorized as social (or government) health insurance and private health insurance. Where a system is financed by compulsory contributions mandated by law or taxes and the system provisions as specified by legal status, it is social (or government) health insurance plan. On the other hand, private health insurance is usually financed on a group basis but most plans also provide for individual policies (Adeoye, 2015).
Health Insurance, according to (Adeoye, 2015) is assuming the status of a global phenomenon. It was first introduced in Germany in 1883 under General Von Bismark’s old age and disability insurance scheme. Since then, health insurance has continued to gain prominence in the other industrialized nations like France, United Kingdom etc. Developing countries too have joined in beaming their health search light on health insurance. Prominent among them are Costa-Rica, Brazil, Bangladesh, China, India, Pakistan, Thailand, etc. In Africa it has been introduced in Tanzania, Kenya, Ghana, South Africa, Zimbabwe etc (Agada-Amade, 2007). In Nigeria, the rising cost of medical care, coupled with poor funding of the health care sector by government, in addition to severe down turn in the Nigerian Economy in the 1980’s and 1990s resulted in the abysmal patronage of the orthodox medical and other healthcare or health institutions (Afoloyan-Oloye,2008). Most of these health institutions either down-sized or closed down completely and their health practitioner’s brain-drained for greener pasture. Majority of the people according to Afoloyan-Oloye (2008) resorted to patronizing alternative health care practitioners, such as the herbalists and the spiritualists. Mortality from common diseases became the order of the day. This resulted in government implementing various intervention designs which included the Bamako initiative, user-fee and Drug Revolving Fund. After several committees and commissions, the Federal Government approved the National Health Insurance Scheme (NHIS) in 1989 as a viable means of health care financing for the achievement of easy access to quality health care for the Nigerian people (Adeoye, 2015). It was formally launched on October 15, 1997 and the decree was signed into law in May 1999. National Health Insurance Scheme (NHIS) is a body established under Act 35 of 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost (Adeoye, 2015). NHIS according to Mgbe & Kevin (2014), is a social security system adopted by Nigerian Government to guarantee the provision o needed health services to persons on the payment of token contribution to the common pool, at regular intervals. In the context of this study, NHIS is a system o health care financing introduced by Federal Government of Nigeria to address the problems of health care delivery which has been affected by challenges. It can be seen as a typical example of Public Private Partnership [PPP] in health care delivery in Nigeria. Its main goal is to enhance the health status of the citizens through provision of financial risk protection and customer satisfaction. The hope of the average Nigerian to have a reliable and affordable healthcare delivery system has been brightened with the take-off of the long awaited National Health Insurance Scheme (Mgbe & Kevin, 2014).
1.2 Statement of the Problem
The introduction of National Health Insurance Scheme (NHIS) as a health care financing mechanism should be welcomed with enthusiasm and sense of relief by all stakeholders in the health care industry, especially Federal Civil Servants. Dogo (2008), are of the opinion that National Health Insurance Scheme, which is a health care risk spreading mechanism is probably what is required to solve the problem of inequality in the provision of health care services in Nigeria. Thus the scheme was proposed to help spread the risks and minimize the costs of health care. Regrettably the emergence of NHIS seems not to gain the much expected acceptance, support and cooperation from the civil servants. Ononokpo (2010) observed that majority of civil servants are still reluctant with accepting NHIS programme. According to him, they are all suspicious of government’s motive, intention and strategies especially when they realize that there will be monthly deduction from their salaries as their contribution into the “solidarity pool” for running the scheme. Anecdotal records and personal experience as a health care worker with the NHIS have shown that many civil servants fail to access the NHIS services. Moreso, there is dearth of literature on why many of these civil servants who are expected to be aware of the services and the benefits do not access the service. The questions raised in this study are: what knowledge do the Civil Servants have concerning NHIS programme? What is the perception of Civil Servants on NHIS program? What is the perception of the Civil Servants on the quality of care provided by the NHIS programme? This study is an attempt to address the above questions
1.3 Objective of the Study
The objectives of the study are;
- To determine the knowledge of Federal Civil Servants on NHIS.
- To determine the perception of Federal Civil Servants on NHIS programme.
- To ascertain the perception of Federal Civil Servants on the quality of care provided under the NHIS programme.
- To determine the differences in the opinion of users and the non-users of the NHIS programme among Federal Civil Servants
1.4 Research Hypotheses
The following have been put forward for testing
- H0: There is no significant difference in the perception of users and non-users of the NHIS programme among Federal Civil Servants
H1: There is significant difference in the perception of users and non-users of the NHIS programme among Federal Civil Servants
- H0: There is no significant association between Federal Civil Servants’ grade level and their knowledge of NHIS programme.
H1: There is significant association between Federal Civil Servants’ grade level and their knowledge of NHIS programme.
1.5 Significance of the Study
The findings of the study will reveal the knowledge and perception of Federal Civil Servants on NHIS programme. If their views and perceptions are positive the civil servants will be encouraged to uphold them by the workers in the NHIS. If their views are negative, there will be need for enlightenment of civil servants on the benefit of NHIS by the workers in the NHIS through special sensitization seminars. If the result indicates that the Federal Civil Servants do not have enough knowledge, it will serve as a reason for the NHIS workers, HMOs and the government to organize public enlightenment programme and appropriate information on the concept, objectives, roles, and responsibilities, operations of the scheme and benefits of NHIS. This will enable Federal Civil Servants to make informed choices on adoption of the scheme. Good understanding and awareness will create positive impact on them. If findings show good knowledge and perception, the civil servants will be encouraged to maintain it. The findings will equally motivate NHIS workers and health policy makers to step up effort in the area of sensitization, seminars, and workshops with a view of raising the level of awareness of the people regarding NHIS, their engendering positive attitude and adoption of the scheme. NHIS and other operators of the scheme (providers and HMOs) will benefit from the findings of the study, as it will help them to re-appraise their functions and responsibilities and make adjustments where necessary with a view of making NHIS more attractive to Federal Civil Servants to adopt the scheme. The findings will also serve as a guide for future planning, monitoring and evaluation of the programme by the federal government.
1.6 Scope and Limitation of the Study
The scope of the study covers knowledge and perception of the federal civil servants towards health insurance scheme. 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
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 Terms
Federal Civil Servants:
Refer to all levels of the federal government employees (junior and senior civil servants)
Perception of NHIS Among Employee:
Refer to feelings, opinions and views about NHIS, whether they want the scheme to continue or not and problems they encounter in the scheme. Knowledge about NHIS: refer to the respondents awareness or understanding of employees about the NHIS programs, what the civil servants identify as role of NHIS, advantages inherent in NHIS like curative services for common ailments and injuries, primary eye care services etc. 40% and below is poor knowledge, 41% – 69% is fair knowledge, 70% and above is good knowledge.
Perception on Quality of Care Provided:
Refer to the enrollees view/opinion on the care received, in terms of the promptness, the time spent to see the Doctor, relationship with the Doctor, relationship with the hospital workers, whether excellent, very good, good, fair, and poor.
Users of NHIS:
Refer to registered civil servants who have accessed NHIS services such as visiting a hospital for healthcare service.
Non Users of NHIS:
Refer to registered civil servants who have not accessed NHIS services such as visiting a hospital healthcare
Summary, Conclusion and Recommendation
It is important to ascertain that the objective of this study was to ascertain knowledge and perception of the federal civil servants towards health insurance scheme
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 of federal civil servants towards health insurance scheme
This study was on knowledge and perception of the federal civil servants towards health insurance scheme. Four objectives were raised which included: To determine the knowledge of Federal Civil Servants on NHIS, to determine the perception of Federal Civil Servants on NHIS programme, to ascertain the perception of Federal Civil Servants on the quality of care provided under the NHIS programme, to determine the differences in the opinion of users and the non-users of the NHIS programme among Federal Civil Servants. In line with these objectives, three research hypotheses were formulated and three null hypotheses were posited. The total population for the study is 200 staff of federal civil servants in AMAC, Abuja. The researcher used questionnaires as the instrument for the data collection. Descriptive Survey research design was adopted for this study. A total of 133 respondents made up directors, administrative staff, senior staff and junior staff was used for the study. The data collected were presented in tables and analyzed using simple percentages and frequencies
From the foregoing this study has been able to examine the knowledge and perception of Federal Civil Servants in AMAC towards NHIS.
- The study has identified the knowledge of the federal civil servants on NHIS. The civil servants had fair knowledge of NHIS and civil servants who are graduates had good knowledge of the scheme.
- The workers have positive perception towards NHIS which further explains why many of them have participated in the scheme. Their gender do not affect their perceptions.
- Quality service delivery was attributed to the scheme by participants. A high level of satisfaction was expressed by many of them after utilization of the scheme. Workers who participated had a better perception of the scheme than those who are yet to utilize the scheme
The following recommendations were made based on the study:
- Government and other stakeholders in the scheme need to continue to organize awareness programmes that will enhance the interest among workers in the formal sector.
- Intensified campaign should emphasize on the objective, and benefits of the scheme, using the mass media as a way of reaching a vast majority of the workforce.
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