Utilization of Community Based Health Insurance Scheme among the Vulnerable: An Urban City Experience in Nigeria

Abstract

Background: Universal health coverage is based on the declaration that health is a fundamental human right with equity being paramount. The National Health Insurance Scheme (NHIS) was set up by the Nigerian government to enable every citizen to access basic health care as part of universal health coverage. The community-based health insurance scheme (CBHIS) as part of the NHIS was at the same time also set up to take care of the informal sector. This is meant to ensure that not just a particular group has access to health care but is also available to all individuals within different groups by whatever classification that is used. Objective: We sought to assess the utilization of CBHIS among a group of low-income earners (petty traders) in the urban city of Nnewi in South Eastern Nigeria. Methodology: This is a cross-sectional descriptive study of 400 petty traders using a multi-stage sampling technique. Data was collected using a pretested, semi-structured interviewer-administered questionnaire. Statistical Analysis was done using SPSS V25. Ethical approval was obtained from the health research and ethics committee of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Result: The majority (62.5%) of the petty traders were females with 26% of them aged between 36 and 45 years. While 56.5% of the people were aware of the existence of CBHIS in their community, only 27.5% utilized it. Major factors preventing utilization were feelings of loss of money if no sickness was recorded, lack of trust in the insurance scheme, poor understanding of the scheme structure, and difficulty in locating service providers. Conclusion: Access to basic healthcare services is essential for every individual. Families need to be protected from the financial hardship of huge medical bills. Although there is a high level of acceptance of CBHIS, utilization remains very low. The poor knowledge of the availability of the scheme, operational system of the scheme, and lack of funds has contributed to poor enrollment among the vulnerable.