Assessment of design and anticipated challenges in the implementation of State Supported Health Insurance Scheme in a South West State, Nigeria

Abstract

Background: Poor health indices in most low and middle-income countries are due to inadequate access to available health care. In Nigeria, the National Health Insurance Scheme (NHIS) devolved to State Supported Health Insurance Programme (SSHIP), a new approach aimed at improving access to health care and achieving Universal Health Coverage (UHC). Currently, not much is known about the design of SSHIP, anticipated challenges associated with its implementation, and plans to mitigate and appropriately address them. To elicit useful information about these (anticipated) challenges, the study was carried out among stakeholders who were directly involved in the design of the scheme in Oyo State, Nigeria. Findings will help to identify likely gaps needed to be addressed at the early stage of the scheme. This will contribute to efforts in implementing a sustainable health insurance scheme in the state. Methods: This is a descriptive cross-sectional study. To allow the researchers achieve the study objectives, a purposive sampling technique was employed in selecting all the 12-man Steering Committee members in the State Health Insurance Scheme for interviews. A validated In-Depth Interview (IDI) guide was used to collect qualitative data from the target population. Transcripts from the data were analyzed using the thematic approach with the aid of ATLAS Ti software package version 7. Ethical approval was obtained from the Oyo State Ministry of Health Research Ethics Committee, Ibadan Nigeria. Consent was also sought and obtained from individual study participants. Results: The concept and design of the SSHIP are fundamentally the same as any other social health insurance scheme like the NHIS, however, certain differences exist. In Oyo State, the SSHIP is made compulsory, it is supported by the organized trade unions, and policies (and benefits packages) are stratified based on the financial ability of individuals to subscribe to different premium platforms. Certain features of the scheme such as enrolment, premium determination and collection methods, and the absence of government funding support are likely areas of challenges that may militate against its sustainability. Stakeholders need to address these appropriately. Likewise, awareness and understanding the basic design of the scheme among potential beneficiaries will go a long way in the efforts to implement and sustain a successful scheme. Conclusions: Findings in this study are suggestive that the State SSHIP enjoys good support from stakeholders in Oyo State. However, identified likely areas in the design of the scheme that could become a challenge to the scheme need to be appropriately addressed to ensure its successful implementation and sustainability. We accept as a limitation to more robust information the inability to interview certain key stakeholders such as the State Chairman of the Nigerian Labor Congress and some of the potential beneficiaries of the scheme.