Resum
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 analysed 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 organised 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 Labour Congress and some of the potential beneficiaries of the scheme.
Keywords: State-supported health insurance scheme, Universal health coverage, Health financing
Résumé
Contexte : Les mauvais indicateurs de santé dans la plupart des pays à revenu faible et intermédiaire sont dus à un accès insuffisant aux soins de santé disponibles. Au Nigéria, le régime national d’assurance maladie (NHIS) a été décentralisé en un Programme d’assurance maladie financé par l’état (SSHIP), une nouvelle approche visant à améliorer l’accès aux soins de santé et à atteindre la couverture de santé universelle. Actuellement, on en sait peu sur la conception du SSHIP, sur les défis anticipés associés à sa mise en œuvre et sur les plans pour les atténuer et les résoudre de manière appropriée. Pour obtenir des informations utiles sur ces défis (anticipés), l’étude a été réalisée auprès des parties prenantes directement impliquées dans la conception du programme dans l’État d’Oyo, Nigéria. Les constats aideront à identifier les lacunes susceptibles d’être traitées tout au début du programme. Ceci contribuera aux efforts déployés pour mettre en place un régime d’assurance maladie durable dans l’État.
Méthodes : Le plan d’étude descriptif transversal a été utilisé. Pour permettre aux chercheurs d’atteindre les objectifs de l’étude, une technique d’échantillonnage par choix raisonné a été utilisée pour sélectionner tous les membres du Comité directeur composés de 12 membres du régime d’assurance maladie de l’État pour des entretiens. Un guide validé d’interview en profondeur (IDI) a été utilisé pour collecter des données qualitatives auprès de la population cible.Les transcriptions des données ont été analysées à l’aide de l’approchethématiqueà l’aide du logiciel ATLAS Ti version 7. L’approbation éthique a été obtenuedu Comité d’éthique de la recherche du ministère de la santé de l’État d’Oyo,Ibadan, Nigeria.Le consentement a également été demandé et obtenu des participants individuels à l’étude.
Résultats : Le concept et la stratégie du SSHIP sont fondamentalement identiques à ceux de tout autre régime d’assurance sociale de santé tel que le NHIS, toutefois, il existe certaines différences. Dans l’État d’Oyo, le SSHIP est rendu obligatoire, soutenu par les syndicats organisés et les politiques (ainsi que les paquets d’avantages) sont stratifiés en fonction de la capacité financière des individus à s’abonner à différentes plates-formes premium. Certaines caractéristiques du programme, telles que l’inscription, la détermination des primes et les méthodes de perception, ainsi que l’absence d’aide financière de la part du gouvernement sont des domaines susceptibles de poser des problèmes qui pourraient nuire à sa durabilité. Les parties prenantes doivent y répondre de manière appropriée. De même, la connaissance et la compréhension de la stratégie de base du système parmi les bénéficiaires potentiels contribueront grandement à la mise en œuvre et au maintien d’un système réussi.
Conclusions : Les résultats de cette étude sont suggestifs que le programme d’assurance maladie financé par l’état bénéficie d’un bon soutien des parties prenantes dans l’Etat d’Oyo.Cependant, les domaines identifiés dans la conception du système susceptibles de poser problème, doivent être traités de manière appropriée pour assurer sa mise en œuvre et sa durabilité. Nous acceptons comme limite aux informations plus fiables l’incapacité d’interviewer certains acteurs clés tels que le président du Congrès des Travailleurs Nigérian dans l’Etat d’Oyo et certains des bénéficiaires potentiels du programme.
Mots - clés : Régime d’assurance maladie financé par l’État, couverture de santé universelle, financement de la santé
Correspondence: Mr. D.A. Adewole, Department of Health Policy and Management, College of Medicine,
University of Ibadan, Ibadan, Nigeria. E-mail: ayodadewole@yahoo.com or adwdav001@myucl.ac.za
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