Browsing by Author "Adewole David Ayobami"

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    Administrative Perspectives on the Implementation and Sustainability of State-Supported Health Insurance Schemes in Nigeria: A Descriptive Qualitative Study
    (2024-12-10) Effiong Fortune Benjamin; Hassan Ibrahim Adebayo; Dine Roseline Dzekem; Olawuyi Dimeji Abdulsobur; Adewole David Ayobami
    Background: Since the state-supported health insurance schemes (SSHIS) began in Nigeria, perspectives of implementers and other administrative actors have been under-documented in the program evaluations. Bridging this information gap is crucial to addressing the challenges impeding the scheme's impact. Therefore, this study investigated the administrative stakeholders' perspective on the implementation and sustainability of the SSHIS in Nigeria. Methods: This study adopted a descriptive qualitative design. Participants were state actors, public and private healthcare providers, and ward committee members purposely selected from six states with a functional SSHIS, representing Nigeria's six geo-political zones. The states included Cross River (South-South), Enugu (South-East), Oyo (Southwest), Kwara (North-Central), Sokoto (Northwest) and Taraba (Northeast) states. 30 key informant interviews (KII) were conducted among these stakeholders exploring the design, successes, challenges, and personal recommendations relating to the SSHIS operation in their states. Data analysis was performed using NVIVO version 11. Results: Across the states, the SSHIS design was adaptive covering formal, informal, and low-income vulnerable groups. Reported impact of the scheme related to improved state health indices, infrastructure, access equity, and funding systems. Challenges threatening the coverage and sustainability of the SSHIS included low public awareness and buy-in and other governmental (processes and payments), economic (funding and costs), manpower, and environmental (insecurity and facility inaccessibility) factors to which possible corrective measures were suggested. Conclusion: Administrators offer critical policy action points to enhance SSHIS impact in Nigeria towards universal health coverage. Future studies may investigate the key challenges and the effectiveness of the suggested solutions.
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    Coverage and Predictors of Enrollment in the State-Supported Health Insurance Schemes in Nigeria: A Quantitative Multi-Site Study
    (2024-12-10) Effiong Fortune Benjamin; Dine Roseline Dzekem; Hassan Ibrahim Adebayo; Olawuyi Dimeji Abdulsobur; Isong Idongesit Kokoabasi; Adewole David Ayobami
    Background: In efforts to advance universal healthcare coverage (UHC) in Nigeria, the federal government empowered sub-national entities such as states to develop and implement their respective state-supported health insurance schemes (SSHIS). This study assessed the coverage and predictors of enrollment in the SSHIS in six Nigerian states. Methods: This study used a quantitative cross-sectional design. Respondents were recruited across six Nigerian states with operational SSHIS, corresponding to the country's six geopolitical zones. These include the Cross River, Enugu, Oyo, Kwara, Sokoto, and Taraba states, representing the South-South, South-East, South-West, North-Central, North-West, and North-East zones respectively. Data were collected from community members in congregate settings such as markets, churches/mosques, schools, bus stations/parks, and healthcare facilities. Descriptive, bivariate, and multivariate analyses were conducted using SPSS version 25. Results: The number of study respondents was 3732. The greater majority of the respondents were self-employed 1855(49.7%) and were living with an average monthly income of <10,000 naira 1175(31.5%). Coverage of the state health insurance was highest in the North-Central Kwara State 326(37.3%), but lowest in the South-Eastern Enugu State 6(1%). Among beneficiaries, overall satisfaction with the scheme was highest in Oyo State 73(77.7%), but lowest in Cross River State 16(32.7%). After adjusting for confounders, several covariates were identified as decreasing the odds of enrolling into the schemes; however, lack of awareness about the scheme was most significant across all the six states. Conclusion: Low coverage due to poor awareness, financial barriers, and enrollee dissatisfaction currently affect the SSHIS in Nigeria. To improve enrollment and sustainability, nationwide educational campaigns and consolidation of health insurance schemes are recommended.