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CHAPTER ONE
INTRODUCTION
Background Of The Study
Health services are judged to be unsatisfactory and inadequate in meeting the needs and demands of the public as reflected by the poor state of health of the population (FMOH, 1998) cited in Kriss (2017). It is realistic to argue that some of the deaths and serious illnesses which occur among Nigerians are due to conditions which are easily preventable with simple remedies. Lack of timely and appropriate care often increases the risk of serious complications in the course of minor ailments (Irinoye, 2018). The current high rate of morbidity and mortality can be substantially reduced by a more rational application of available resources, even at the time of financial stringency (Irinoye, 2018).
Various reform programmes have been put in place and government has expressed its determination to pursue a bold reform of the system. In the attempt by the government to ensure that all citizens attain a state of perfect physical, mental and social well being, it has formulated and implemented National Health Policy (Zeckhauser, 2020). The National Health Policy and Strategy to achieve health for all Nigerian’s came into effect in 1988 and was revised in 2004.
The main policy thrust of the National Health System includes Care Resources, National Health Interventions and Services Delivery, National Health Information Systems, Partnership for Health Development, National Research and Health Care Laws. In spite of a well structured health system, development of the Primary Health Care (PHC) has not improved the health experience of the population especially those in rural areas (Ekman, 2017). The health sector’s contribution to national development remains a serious issue. Therefore, as part of government effort to address the problems in the sector, the National Health Insurance Scheme (NHIS) was initiated to address the health problems in Nigeria. The NHIS is a corporate body established under Act 35 of 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost. Health Insurance is an approach that protects insured persons from paying high treatment costs during an episode of sickness. The basic health insurance process is that a client makes a regular payment to a managing institution. This institution is responsible for holding the payments in a fund and paying a healthcare provider for the cost of the consumer’s care (Dutta, & Hongoro, 2017).
Data from the NHIS in 2011 shows 5% of the population are registered on the scheme (NHIS 2012b). Majority of those covered are in the employment of the federal and state governments and live in the urban areas (Ekman. 2017). However, more than 60% of Nigerians belong to the informal sector and live in rural areas on less than $1 a day (as cited by UPI, 2012). Because they lack sufficient financial resources when faced with health challenges, they cannot afford good quality health care. Out-Of-Pocket (OOP) financing of health remains high at about 95.3% of the private expenditure on health (PvtHE) in 2010 (PvtHE as a percentage of Total Health Expenditure {THE} was 62.1% in 2010), and usually has a catastrophic effect on the poor. Many Nigerians have lost their lives due to their inability to meet this need (Zeckhauser, 2020). NHIS is usually designed to significantly cater for the welfare of the citizens and especially the less privileged in the society (Zeckhauser, 2020). This, in essence, would guarantee access to care with financial risk protection. The scheme has been in operation since 2005 and the target date for achieving universal health coverage was 2015. From the above, this study seek to ascertain the impact of National health insurance on aged citizens of Nigeria.
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Statement Of The Problem
Nigeria’s health indicators have either stagnated or worsened during the past decade despite the federal government‟s efforts to improve healthcare delivery. Nigeria‟s life expectancy of 52.3years is below the African average of 56.05years, while child and maternal mortality rates are astounding. Annually, one million children die before the age of five due mostly to neonatal causes, malaria and pneumonia. Maternal mortality is 630 per 100,000 live births which is comparable to low-income countries such as Lesotho and Cameroon (Irinoye, 2018). An estimated 3.3 million Nigerians are infected with HIV and access to prevention, care and treatment is minimal. Nigeria also continues to combat the double burden of both communicable and noncommunicable diseases.
The National Health Insurance Scheme (NHIS) is an attempt by the Nigerian federal government to adopt universal health coverage (UHC) for her citizens. Dutta and Hongoro (2017) define UHC as ensured access to and use of high-quality health care services by all citizens and protection for all individuals from any catastrophic financial effect of ill-health. On their part, Schellekens (2016) see UHC as referring to health systems providing both access to health services and financial protection which includes avoiding out-of-pocket payments that reduce the affordability of services and ideally some compensation for productivity loss due to illness(Ekman, (2017). The aged citizens as used in this study refers to all persons of the population aged 50years and older in Nigeria. From the above, this study seek to ascertain the benefit of health insurance scheme on the aged citizens of Nigeria using Ilorin West Local Government Area Of Kwara State as a case study
Objectives Of The Study
The overall aim of this study is to critically examine the benefit of health insurance scheme on the aged citizens of Nigeria using Ilorin West Local Government Area Of Kwara State as a case study. Hence, the study will be channeled to the following specific objectives;
1. Investigate the level of awareness of National health insurance scheme among aged Nigerians.
2. Determine whether national health insurance scheme contribute to health-related welfare of aged Nigerians.
3. Ascertain whether national health insurance scheme improve the quality of live of aged Nigerians.
4. Ascertain whether national health insurance scheme gives access to health services and financial protection to aged Nigerians.
Research Question
The study will be guided by the following questions;
1) What is the level of awareness of National health insurance scheme among aged Nigerians?
2) Does national health insurance scheme contribute to health-related welfare of aged Nigerians?
3) Does national health insurance scheme improve the quality of live of aged Nigerians?
4) Does national health insurance scheme give access to health services and financial protection to aged Nigerians?
Significance Of The Study
The significance of this study is to highlight the ineffectiveness of aging programs and services in Nigeria, with a view to advocating changes in policy formulation and implementation of health programs and services so as to affect the elderly population. Currently, there are no overt programs and services for the elderly in Nigeria because there has not yet been a policy for the care of seniors in Nigeria. This paper will as well make advocacy for the establishment of such facilities in order to better the lot of the elderly population in Nigeria.
Additionally, subsequent researchers will use it as literature review. This means that, other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regards to the benefit of health insurance scheme on the aged citizens of Nigeria.
Scope Of The Study
This study is structured to generally examine the benefit of health insurance scheme on the aged citizens of Nigeria. However, the study will further investigate the level of awareness of National health insurance scheme among aged Nigerians, determine whether national health insurance scheme contribute to health-related welfare of aged Nigerians, ascertain whether national health insurance scheme improve the quality of live of aged Nigerians, and ascertain whether national health insurance scheme gives access to health services and financial protection to aged Nigerians. The population of this study covers residents in Ilorin west local Government Area Ilorin, Kwara state.
Limitation Of The Study
Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.
Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.
Definition Of Terms
NHIS: National Health Insurance Scheme.
UHC: Universal Health Coverage.
PHC: Primary Health Care
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