Journal of Health and Medical Sciences

ISSN 2622-7258

Published: 01 October 2020

Evaluation of Enrollees’ Perspectives on the Operations of the National Health Insurance Scheme in Nigeria

Oluwaseye O Adesokun, Kanayo P Osemene, Matthew O Ilori, Romanus M Ihekoronye

Obafemi Awolowo University Health Centre (Nigeria), Obafemi Awolowo University (Nigeria)

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Pages: 411-422

Keywords: National Health Insurance Scheme; Healthcare Services, Nigeria


Background: The National Health Insurance Scheme (NHIS) was established in 2005 to act as an alternative source of funding for health care services but marred with operational problems. Objective: The study examined the mode of operation of the NHIS and assessed its adequacy to achieve set objectives in the face of contending factors from the point of view of enrollees. Methods: A descriptive cross-sectional survey of 300 enrollees in three tertiary health facilities in Southwestern Nigeria was undertaken between August and October, 2019. Participants were selected using a combination of quota and simple random sampling methods. Primary data were obtained using semi-structured questionnaires and focus group discussions. Frequency, percentages, weighted means and relative importance indices were used to analyse data at p<0.05 level of significance. Results: Response rate for both focus groups and questionnaires was 100 %. Mean age of respondents was 43.11 years while that of focus groups discussants was 40.81 years. Enrollees understood the objectives of the NHIS and its components especially its focus on improving service efficiency (85%). However, they posit that the mode of operations was inadequate to accomplish those goals. Factors identified as responsible for this include capacity limitations in terms of infrastructure (89%), human resources (84%), and financial resources (66%); corruption (65%) as well as poor responsiveness by service providers (44%).Conclusion: Enrollees in the NHIS in Nigeria understand the goals of the scheme even though more enlightenment is needed to drive home the philosophy. The mode of operations is inadequate to achieve the objectives of the scheme. Reforms are needed to address inadequacies in infrastructure, capacities and management of services.


  1. Abiola, A.O., Ladi-Akinyemi, T.W., Oyeleye, O.A., Oyeleke, G.K., Olowoselu, O.I., &  Abdulkareem, A.T. (2019). Knowledge and utilisation of National Health Insurance  Scheme among adult patients attending a tertiary health facility in Lagos State, South-Western Nigeria. African Journal of Primary Healthcare and Family Medicine, 11(1), 2018. doi: 10.4102/phcfm.v11i1.2018

  2. Adekola, L. (2015). Health Insurance: The Theoretical Basis of Administration. Available at adekola#.VL9oC2Mpe00. Retrieved February 20, 2020.

  3. Adeniyi, A.A., & Onajole, A. T. (2010). The National Health Insurance Scheme (NHIS): A Survey of

  4. Knowledge and Opinions of Nigerian Dentists' in Lagos. African Journal of Medicine and Medical Sciences, 39(1), pp 29-35.

  5. Adesina, D. (2019). The National Health Insurance Scheme: The Nigerian Doctor Available at Retrieved Dec.15, 2020.

  6. Agba, A.M.O, Ushie, E.M., & Osuchuchwu, N.C. (2010). National Health Insurance Scheme and Employee’s Access to Health Services in Cross River State. Global Journal of Human Social Science, 10 (7), pp 9-16.

  7. Azuogu, B.N., Madubueze, U.C., Alo, C, Ogbonnaya, L.U. & Ajayi, N.A. (2016). Level of awareness, and factors associated with willingness to participate in the National Health Insurance Scheme among traders’ in

  8. Abakaliki main market, Ebonyi State, Nigeria; African Journal of Medical and Health Sciences, 15 (1), pp18-23. doi: 10.4103/2384-5589.183887

  9. Dutta, A & Charles, H. (2013). Scaling up National Health Insurance in Nigeria: Learning from Case Studies of India, Colombia, and Thailand. Washington, DC: Futures Group, Health Policy Project. Available at; Retrieved May 21, 2019

  10. Eboh, D. (2008). National Health Insurance Scheme: Just a Name or a Model for Realistic Change in Health Care Delivery in Nigeria. Available at http://www.mebodomanagement Retrieved Sep 12, 2019.

  11. Edeh, J.N. & Udoikah, J.M. (2015). National Health Insurance Scheme and Administration in Nigeria: An Assessment.  International Journal of Science and Research, 6 (4), pp 1-12.

  12. Federal Government of Nigeria. (1999). The National Health Insurance Act 1999. Available at Retrieved Sep 10, 2019

  13. Federal Ministry of Health Nigeria. (2014). Harmonized Country Plan of Priority Interventions 2014-2015. Abuja: Federal Ministry of Health. Available from: Accessed June 2, 2020

  14. Gustafsson-Wright E, & Schellekens O. (2013). Achieving Universal Health Coverage in Nigeria One State at a Time: A Public-Private Partnership Community-Based Health Insurance Model. Brookings, Washington DC, USA. Available at https://+Achieving+universal+health+coverage+in+Nigeria+one+state+at+a+time%3A+a+public-private+partnership+community-based+health+insurance+model.&btnG; Retrieved Aug 12, 2019.

  15. Hao, Y. (2015). Universal Health Insurance Coverage for 1.3 Billion People: What Accounts for China's Success? Health Policy, 119 (9), pp 1145–1152.

  16. Ibe, O., Honda, A., Etiaba, E., Ezumah, N., Hanson, K. & Onwujekwe, O. (2017). Do beneficiaries’ views matter in health care purchasing decisions? Experiences from the Nigerian tax-funded health system and the formal sector social health insurance program of the national health insurance scheme. International Journal of Equity in Health, 16:216.

  17. Ministry of Health. (2013). Federal Republic of Nigeria National Health Insurance Scheme Handbook. Operational Guidelines on National Health Insurance Scheme 2006. National Health Insurance Scheme. Nigeria Medical Practice, 43(2): p 2.

  18. Mohammed, D. (2015) Expanding Health Insurance Coverage in Nigeria. Available at Retrieved Sep 10, 2019.

  19. NHIS. (2012) National Health Insurance Scheme. Operational Guidelines. Available at Retrieved Sep 5, 2019.

  20. Odeyemi IAO, & Nixon J. (2013). Assessing Equity in Healthcare through the National Health Insurance Schemes of Nigeria and Ghana: A Review-Based Comparative  Analysis. International Journal for Equity in Health, 2: 9.DOI

  21. Ogunbameru, O.A., & Ogunbameru, B.O. (2018). The Dynamics of Social Science  Research; Penthouse Publications, Ibadan Nigeria, pp 134-9

  22. Olonade O, Olawande, T.I., Alabi, O.J. & Imhonopi, D. (2019). Maternal mortality and maternal health care in Nigeria: Implications for socioeconomic development. Open Access Macedonian Journal of Medical Sciences, 7(5), pp 849–855. doi:10.3889/oamjms.2019.041

  23. Onoka, C.A., Onwujekwe, O.E., Uzochukwu, B.S., & Ezumah, N.N. (2013). Promoting universal financial protection: Constraints and enabling factors in scaling-up coverage with social health insurance in Nigeria. Health Research and Policy Systems, pp 11:20.

  24. Onwujekwe, O., Ezumah, N., Mbachu, C., Obi, F., Ichoku, H., Uzochukwu, B. & Wang, H. (2019). Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen? BMC Health Services Research, 19661.

  25. Onyedibe, K.I., Goyit, M.G. & Nnadi, N.E. (2012). An Evaluation of the Health Insurance Scheme (NHIS) in Jos; a North-Central Nigerian City. Global Advanced Research Journal of Microbiology, 1(1), pp 5-12.

  26. Osungbade, K.O., Obembe, T.A. & Oludoyi, A. (2014). User’s satisfaction with services provided under National Health Insurance Scheme in South Western  Nigeria. International Journal of Tropical Diseases and Health. 4(5), pp 595–607. doi:10.9734/IJTDH/2014/7280

  27. Sparkes, S.P., Bump, J.B., Özçelik, E.A., Kutzin, J. & Reich, M.R. (2019). Political Economy Analysis for Health Financing Reform, Health Systems and Reforms 5(3), pp183-194, doi: 10.1080/23288604.2019.1633874

  28. Stuckler, D., Feigl, A.B., Basu, S. & McKee, M. (2010). The Political Economy of Universal Health Coverage: Background Paper for the First Global Symposium on Health Systems Research. Technical Report. WHO, Geneva. Available at; Retrieved January26, 2020

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