KNOWLEDGE AND PERCEPTION OF FEDERAL CIVIL SERVANTS IN ABUJA MUNICIPAL AREA COUNCIL TOWARDS NATIONAL HEALTH INSURANCE SCHEME
National Health Insurance Scheme (NHIS) is a system of healthcare financing introduced by Federal Government of Nigeria to help reduce the risks and minimize the costs of healthcare. Since its inception, only the Formal Sector Social Health Insurance Programme (FSSHIP) has comprehensively taken off. This study investigated the knowledge and perception of Federal Civil Servants in Abuja Municipal Area Council (AMAC), Federal Capital Territory (FCT). A sample size of 383 Civil Servants were selected. The instrument for data collection was a researcher – designed 30 item questionnaire. Data were analysed using descriptive statistics such as frequencies, percentages, mean and standard deviation. Hypotheses were tested using inferential statistics such as student’s t-test and Chi-square. Findings showed that majority of the civil servants (56.3%) had fair knowledge of NHIS programme. The civil servants had a positive perception of the NHIS programme (Overall Mean = 2.81). Majority of the respondents (60%) accessed care under the scheme. Findings from the study also showed that the civil servants who utilized the scheme had a better perception of the programme (mean = 2.84) when compared to those who didn’t (P = 0.038). Education was significantly associated with knowledge and positive perception of the programme. There was no association between grade level and knowledge of NHIS programme. In addition, their perception of the programme was not dependent on their gender. The study concluded that intensified campaign on the objectives, benefits and workings of the scheme should be ensured. This should be facilitated by the nurses and use of mass media in order to reach a vast majority of the workforce and enhance their perception of the programme.
of this work.
TABLE OF CONTENTS
CHAPTER ONE INTRODUCTION
Background to the Study . . . . . . 1
Statement of Problem . . . . . . . 3
Purpose of the Study . . . . . . . 4
Research Questions . . . . . . . 4
Research Hypothesis . . . . . . . 5
Significance of the Study . . . . . . 5
Scope of the Study . . . . . . . 6
Operational Definition of Terms . . . . . 6
CHAPTER TWO LITERATURE REVIEW
Conceptual Review . . . . . . . 8
Theoretical Review . . . . . . . 15
Empirical Review . . . . . . . 16
Summary of Literature Reviewed . . . . . 22
CHAPTER THREE RESEARCH METHODS
Research Design . . . . . . . 23
Area of Study . . . . . . . . 23
Population of the Study . . . . . . 24
Sample . . . . . . . . 24
Inclusion Criteria . . . . . . . 24
Sampling Procedure . . . . . . . 24
Instrument for Data Collection . . . . . 25
Validity of the Instrument . . . . . . 25
Reliability of Instrument . . . . . . 25
Ethical Consideration . . . . . . . 26
Procedure for Data Collection . . . . . 26
Method of Data Analysis . . . . . . 26
CHAPTER FOUR PRESENTATION OF RESULTS
Analysis of Results . . . . . . . 27
Summary of Findings . . . . . . . 37
CHAPTER FIVE DISCUSSION OF FINDINGS
Discussion of Major Findings . . . . . . 38
Summary of the Study . . . . . . 39
Implication of the Study to Nursing Practice . . . . 43
Conclusion . . . . . . . . 43
Recommendation . . . . . . . 44
Limitation of the Study . . . . . . 44
Suggestion for Further Studies . . . . . 45
References . . . . . . . . 46
Appendix . . . . . . . . 51
Background to the Study
Health system are designed to improve the standard of health care of the population. Improved funding and management of health systems lead to social stability. Population’s coverage is a clear indicator of the performance of the health system. The policy of National Health Insurance Scheme (NHIS) aims at increasing coverage of the Nigerian population. Health insurance as a health care financing mechanism has become a sought-after approach to the problem of financing healthcare all over the. world. The current concern with financing, and the specific interest in health insurance is often the result of parallel trend; the recognition of basic healthcare for all citizens as a fundamental human right on the one hand, and the difficulties faced by governments in developing and maintaining resources to provide health care through general taxation revenue on the other (Mgbe & Kelvin, 2014). World Health Organization (WHO) has been giving tremendous support and cooperation to nations that pursue their citizen’s welfare through health insurance. They further noted that, nations equally are channeling large chunk of their budget to the attainment of good health for their people.
Health insurance can be categorized as social (or government) health insurance and private health insurance. Where a system is financed by compulsory contributions mandated by law or taxes and the system provisions as specified by legal status, it is social (or government) health insurance plan. On the other hand, private health insurance is usually financed on a group basis but most plans also provide for individual policies (Adeoye, 2015).
Health Insurance, according to (Adeoye, 2015) is assuming the status of a global phenomenon. It was first introduced in Germany in 1883 under General Von Bismark’s old age and disability insurance scheme. Since then, health insurance has continued to gain prominence in the other industrialized nations like France, United Kingdom etc. Developing countries too have joined in beaming their health search light on health insurance. Prominent among them are Costa-Rica, Brazil, Bangladesh,
China, India, Pakistan, Thailand, etc. In Africa it has been introduced in Tanzania, Kenya, Ghana, South Africa, Zimbabwe etc (Agada-Amade, 2007).
In Nigeria, the rising cost of medical care, coupled with poor funding of the health care sector by government, in addition to severe down turn in the Nigerian Economy in the 1980’s and 1990s resulted in the abysmal patronage of the orthodox medical and other healthcare or health institutions (Afoloyan-Oloye,2008). Most of these health institutions either down-sized or closed down completely and their health practitioner’s brain-drained for greener pasture. Majority of the people according to Afoloyan-Oloye (2008) resorted to patronizing alternative health care practitioners, such as the herbalists and the spiritualists. Mortality from common diseases became the order of the day. This resulted in government implementing various intervention designs which included the Bamako initiative, user-fee and Drug Revolving Fund. After several committees and commissions, the Federal Government approved the National Health Insurance Scheme (NHIS) in 1989 as a viable means of health care financing for the achievement of easy access to quality health care for the Nigerian people (Adeoye, 2015). It was formally launched on October 15, 1997 and the decree was signed into law in May 1999.
National Health Insurance Scheme (NHIS) is a body established under Act 35 of 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost (Adeoye, 2015). NHIS according to Mgbe & Kevin (2014), is a social security system adopted by Nigerian Government to guarantee the provision of needed health services to persons on the payment of token contribution to the common pool, at regular intervals. In the context of this study, NHIS is a system of health care financing introduced by Federal Government of Nigeria to address the problems of health care delivery which has been affected by challenges. It can be seen as a typical example of Public Private Partnership [PPP] in health care delivery in Nigeria. Its main goal is to enhance the health status of the citizens through provision of financial risk protection and customer satisfaction. The hope of the average Nigerian to have a reliable and affordable healthcare delivery system has been brightened with the take-off of the long awaited National Health Insurance Scheme (Mgbe & Kevin, 2014).
However, since its inception, it is only the Formal Sector Social Health Insurance Programme of the NHIS that has comprehensively taken off (Agu, 2010). The Formal Sector Social Health Insurance Programme (FSSHIP) is a social health security system in which the health care of employees in the formal sector is paid for, from funds created by pooling the contributions of employees and employers. Contributions are earnings related. The employer pays 10%, while the employee pays 5%, representing 15% of the employees’ basic salary (NHIS, 2012). Given that the Formal Sector Social Health Insurance Programme is new, the federal government of Nigeria chose to exempt its employees from paying their share of 5%, insisting the programme runs on its own 10% contribution for some months. This was meant to secure employees’ confidence in the programme, assuming that once the employees perceive the benefits, contributions will be facilitated. Presently, the Formal Sector Social Health Insurance Programme provides health insurance coverage for contributors, one spouse and four biological children below 18 years of age (National Health Insurance Scheme, 2012).
Despite its take off, NHIS has been characterized by a lot of misconceptions, fears about workability of the scheme, concerns as regards workers’ financial contribution to the scheme overtime and the sincerity of government in financing workers’ health care in the formal sector among others (Adeoye, 2015). There have been mixed feelings about the impact of the programme on workers (Ononokpo, 2010). This study is therefore being conducted to determine the Knowledge and Perception of National Health Insurance Scheme (NHIS) among Federal Civil Servants in Abuja Municipal Area Council (AMAC) Federal Capital Territory (FCT) Abuja. This will serve as baseline for further recommendations to stakeholders in the scheme, and ultimately help in organizing and managing the scheme for better acceptability to the workforce.
Statement of the Problem
The introduction of National Health Insurance Scheme (NHIS) as a health care financing mechanism should be welcomed with enthusiasm and sense of relief by all stakeholders in the health care industry, especially Federal Civil Servants in Abuja. Dogo (2008), are of the opinion that National Health Insurance Scheme, which is a health care risk spreading mechanism is probably what is required to solve the
problem of inequality in the provision of health care services in Nigeria. Thus the scheme was proposed to help spread the risks and minimize the costs of health care.
Regrettably the emergence of NHIS seems not to gain the much expected acceptance, support and cooperation from the civil servants. Ononokpo (2010) observed that majority of civil servants are still reluctant with accepting NHIS programme. According to him, they are all suspicious of government’s motive, intention and strategies especially when they realize that there will be monthly deduction from their salaries as their contribution into the “solidarity pool” for running the scheme.
Anecdotal records and personal experience as a health care worker with the NHIS have shown that many civil servants fail to access the NHIS services. Moreso, there is dearth of literature on why many of these civil servants who are expected to be aware of the services and the benefits do not access the service. The questions raised in this study are: what knowledge do the Federal Civil Servants in AMAC have concerning NHIS programme? What is the perception of Federal Civil Servants in AMAC on NHIS program. What is the perception of the Federal Civil Servants on the quality of care provided by the NHIS programme? This study is an attempt to address the above questions.
Purpose of the Study
The purpose of the study is to determine the Knowledge and Perception of Federal Civil Servants in Abuja Municipal Area Council (AMAC) towards NHIS.
Objectives of the study
Specifically, the objectives are to:
1. determine the knowledge of Federal Civil Servants in AMAC on NHIS.
2. determine the perception of Federal Civil Servants in AMAC on NHIS programme.
3. ascertain the perception of Federal Civil Servants in AMAC on the quality of care provided under the NHIS programme.
4. determine the differences in the opinion of users and the non-users of the NHIS programme among Federal Civil Servants in AMAC.
The following research questions were formulated to guide the study:
1. What knowledge do Federal Civil Servants in AMAC have on NHIS.
2. What is the perception of Federal Civil Servants in AMAC on NHIS programme.
3. What is the perception of Federal Civil Servants on the quality of care provided under the NHIS programme.
4. What are the differences in the opinion of users and the non-users of the NHIS programme among Federal Civil Servants in AMAC.
Ho1: There is no significant difference in the perception of users and non-users of the NHIS programme among Federal Civil Servants in AMAC.
Ho2: There is no significant association between Federal Civil Servants’ level of education and their knowledge of NHIS programme.
Ho3: There is no significant association between Federal Civil Servants’ grade level and their knowledge of NHIS programme.
Ho4: There is no significant association between Federal Civil Servants’ level of education and their perception of NHIS programme.
Ho5: There is no significant association between Federal Civil Servants’ gender and their perception of NHIS programme.
Significance of the Study
The findings of the study will reveal the knowledge and perception of Federal Civil Servants in AMAC on NHIS programme. If their views and perceptions are positive the civil servants will be encouraged to uphold them by the workers in the NHIS. If their views are negative, there will be need for enlightenment of civil servants on the benefit of NHIS by the workers in the NHIS through special sensitization seminars.
If the result indicates that the Federal Civil Servants do not have enough knowledge, it will serve as a reason for the NHIS workers, HMOs and the government to organize public enlightenment programme and appropriate information on the concept, objectives, roles, and responsibilities, operations of the scheme and benefits of NHIS.
This will enable Federal Civil Servants to make informed choices on adoption of the scheme. Good understanding and awareness will create positive impact on them.
If findings show good knowledge and perception, the civil servants will be encouraged to maintain it.
The findings will equally motivate NHIS workers and health policy makers to step up effort in the area of sensitization, seminars, and workshops with a view of raising the level of awareness of the people regarding NHIS, their engendering positive attitude and adoption of the scheme.
NHIS and other operators of the scheme (providers and HMOs) will benefit from the findings of the study, as it will help them to re-appraise their functions and responsibilities and make adjustments where necessary with a view of making NHIS more attractive to Federal Civil Servants to adopt the scheme. The findings will also serve as a guide for future planning, monitoring and evaluation of the programme by the federal government.
Future Researchers will find data generated from the study very useful, as they could build on the findings in furthering researches in this area of knowledge. This study will contribute in the literary world. It will, particularly add to the existing literature in the field of health insurance.
Scope of the Study
This study wase delimited to all Federal Civil Servants within Abuja Municipal Area Council (AMAC). The study will specifically be delimited to the determination of knowledge of NHIS by Federal Civil Servants in AMAC, the perception of Federal Civil Servants in AMAC on NHIS programmes, the perception of civil servants on quality of care under NHIS programme, and the differences in the opinion of users and the non-users of the NHIS programme.
Operational Definition of Terms
Federal Civil Servants: refer to all levels of the federal government employees (junior and senior civil servants) working within Abuja Municipal Area Council (AMAC).
Perception of NHIS among employee: refer to feelings, opinions and views about NHIS, whether they want the scheme to continue or not and problems they encounter in the scheme.
Knowledge about NHIS: refer to the respondents awareness or understanding of employees about the NHIS programs, what the civil servants identify as role of NHIS, advantages inherent in NHIS like curative services for common ailments and injuries, primary eye care services etc. 40% and below is poor knowledge, 41% - 69% is fair knowledge, 70% and above is good knowledge.
Perception on quality of care provided: Refer to the enrollees view/opinion on the care received, in terms of the promptness, the time spent to see the Doctor, relationship with the Doctor, relationship with the hospital workers, whether excellent, very good, good, fair, and poor.
Users of NHIS: refer to registered civil servants in AMAC who have accessed NHIS services such as visiting a hospital for healthcare service.
Non Users of NHIS: refer to registered civil servants in AMAC who have not accessed NHIS services such as visiting a hospital healthcare..