Social Health Insurance in Nigeria: Policy Implications in A Rural Community

Abstract

Social health insurance was introduced in Nigeria in 1999 and had since been restricted to workers in the formal public sector. There are plans for scaling up to include rural populations in a foreseeable future. Information on willingness to participate and pay a premium in the programme by rural populations is dearth. This study sought to document willingness to participate and pay a premium in a social health insurance among indigenous members of a rural community in Nigeria. Adescriptive cross-sectional survey was conducted among heads of households in two randomly selected clusters in Igbo-Ora community. Interviews were conducted using a pre-tested semistructured questionnaire by trained interviewers. The questionnaire sought information on socio-demographic characteristics of the respondents, their awareness about social health insurance and willingness to participate and pay in the scheme. Monthly income was estimated by bidding game approach.Atotal of 410 heads of households were interviewed; their mean age was 45.2 ± 2.2 years. Of the 410 respondents, 66 (16.1%) were aware of an existing social health insurance; 344 (83.9%) were willing to participate, whereas 314 (76.6%) were willing to pay a premium. Respondents who were less than 40 years of age were 1.8 times more likely to be aware of the social health insurance (p = 0.04, OR = 1.83, 95% CI = 1.04 - 3.22) and 2.4 times more likely to participate in it (p = 0.01, OR = 2.42, 95% CI = 1.29 - 4.53) than those aged 40 years and above. Those who had at least secondary education were 2.1 times more likely to be aware than those who had either no formal or at most primary education (p = 0.01,OR= 2.1,95%CI = 1.17 - 3.79). However, those who had either no formal or at most primary education were 3.7 times more likely to be willing to participate than those with at least secondary education (p <_ 0.001, OR = 3.7, 95% CI = 1.96 - 6.98). Respondents with average monthly income greater than N15,000 were 2.3 times more likely to be aware (p = 0.003, OR = 2.3, 95% CI = 1.32 - 3.40) and 3.6 times more likely to be willing to participate in it (p <_ 0.001,OR= 3.6, 95% CI = 1.84 - 7.01) than those with average monthly income of less than N15,000. Awareness of a social health insurance among the study population was generally low, though willingness to participate and pay a premium was high. This enthusiasm is however threatened by the poor-resource setting characteristic of the study area. Socio-economic policy strategies which would empower rural populations are desirable for consideration when implementing a social health insurance.

Keywords: Social health insurance, Awareness, Willingness to participate and pay a premium, Rural community, Igbo Ora