CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

          Satisfaction is a multifaceted concept with numerous definitions and applications. Sociology, finance, theology, law, insurance, urban and regional planning, marketing, music, and entertainment are just a few of the areas where it can be found.

               According to Sirgy, (2012) as can be observed on contentment, satisfaction is often subjective and value-laden because it is dependent on set standards, which can include expectations, valued values, and beliefs, among others. The concept's subjective character largely explains the varied measures used to quantify contentment in various areas of life. The amount of contentment or what constitutes satisfaction for a person or group can be influenced by a number of interconnected elements, such as their social class, ethnicity, or socioeconomic divisions (Bilton, et al 2012).

        Acceptance in person’s perception is a person's assent to the reality of a situation, recognizing a process or condition without attempting to change it or protest it

             The medical system is intended to raise the people's health quality Improved health-care funding and administration leads to societal stability. The coverage of the populace is a clear sign of the healthcare system's performance. The National Health Insurance Scheme (NATIONAL HEALTH INSURANCE SCHEME) strategy attempts to increase cover among Nigerians. Health insurance, as a health-care funding system, has become a popular solution to the problem of health expenditure around the world. The current financial concern, as well as the particular interest in health insurance, is frequently the result of a concurrent trend: on the one side, the acknowledgement of basic healthcare for all persons as a basic human right, and on the other side, states' problems in creating and maintaining resources to provide healthcare coverage through overall tax revenue (Mgbe & Kelvin, 2014).

             The World Health Organization (WHO) has provided enormous cooperation and support to countries that seek to improve the healthcare of their people through medical insurance. They went on to say that countries are allocating a big portion of their budgets to ensuring the health of their citizens. Civil (or government) medical insurance and private medical insurance are two types of medical health coverage. It is a social (or government) health insurance plan when a system is financed by mandatory payments demanded by law or taxes, and the system provisions are set by legal standing. Private health insurance, on either end, is normally paid for as a group, but most plans also allow for particular policies (Adeoye, 2015).

       According to Adeoye (2015) Health insurance is rapidly becoming a global phenomenon. In Italy, it was originally implemented in 1883 as part of General Von Bismark's old age and disability insurance plan. Since then, health insurance has grown in popularity in other industrialised nations such as France and the United Kingdom. Developing nations have also joined the effort to shine a light on health insurance. Costa Rica, Brazil, Pakistan, Russia, Italy, Uzbekistan, Bangkok, and others are prominent among them. Uganda, Kenya, Egypt, South Africa, Mozambique, and other African countries have all adopted it (Agada-Amade, 2007).

          The increasing costs of healthcare in Nigeria, along with the country's insufficient resources of the health-care industry, as well as the severe recession in the Nigerian economy in the 1980s and 1990s, resulted in abysmal support of conventional medical and other healthcare or health organizations (Afoloyan-Oloye,2008). The majority of these health institutions have shrunk or fully closed, and their medical providers have moved on to pastures new.                      

 Adeoye (2015) opined that the majority of Nigerians have turned to traditional health care practitioners such as herbalists and spiritualists for help. The death rate from prevalent diseases became the norm. As a response, the state implemented a variety of intervention models, including the Nigeria initiative, user fees, and the Drug Rotating Fund. The National Health Insurance Scheme  was approved by the Federal Government in the year 1989 as a feasible way of health care funding for the achievement of simple access to quality health care for the Nigerian masses after many committees and commissions (Adeoye, 2015).  On October 15, 1997, it was officially unveiled, and the order was signed into law in May 1999. The National Health Insurance Scheme (NATIONAL HEALTH INSURANCE SCHEME) was created by the Federal Government of Nigeria under Act 35 of 1999 to promote the health of all Nigerians at a fair price (Adeoye, 2015).                 

         According to Mgbe & Kevin (2014), The National Health Insurance Scheme is a social insurance scheme developed by the Nigerian government to ensure the supply of needed health care to people in exchange for a nominal investment to a common pool at regular intervals. In the context of the present study, the National Health Insurance Scheme  is a health-care funding system established by the Federal Government of Nigeria to address difficulties with health-care delivery that have been hampered by challenges. It is a prime illustration of a Public-Private-Partnership (PPP) in Nigerian health care delivery. Its principal objective is to improve individuals' health by providing financial risk insurance and customer happiness. With the launch of the lengthy National Health Insurance Scheme, the typical Nigerian's optimism for a trustworthy and inexpensive health care system has been boosted(Mgbe & Kevin, 2014).

 Nevertheless, only the National Health Insurance Scheme's Formal Sector Social Health Insurance Plan has seen widespread adoption since its start (Agu, 2010).

                 The Formal Sector Social Health Insurance Programme (FSSHIP) is a social health-care system that pays for the healthcare coverage of official employees with funds generated by combining employee and employer donations. Earnings are linked to donations. The employer gives 10% and the employee contributes 5%, for a total of 15% of the owner's basic wage (National Health Insurance Scheme, 2012). Given the newness of the Formal Sector Social Health Insurance Programme, the Nigerian federal government elected to exempt its workers from paying their 5% payment, insisting that the program run on its own 10percentage payment for a period of time. This was done to instill trust in the program among employees, with the expectation that once they saw the advantages, they will contribute more readily. The Formal Sector Social Health Insurance Programme, which was recently established, offers health care coverage to donors, one wife, and four biological children under the age of 18 years (National Health Insurance Scheme, 2012). Despite its success, the National Health Insurance Scheme has been marred by a number of misconceptions, including doubts about the system's viability, worries about workers' financial contributions to the scheme eventually, and the administration's sincerity in paying employees' health care in the formal sector, among many others (Adeoye, 2015). There have been mixed feelings about acceptance and satisfaction of National Health Insurance Scheme among civil servants in Nigeria (Ononokpo, 2010).

                In spite of these achievements however, majority of civil servants in Nigeria still do not have access to medical care when they need it. The government instituted the National Health Policy (NHP) in with the main aim of improving the health status of the masses to allow Nigerians to have wholesome, productive lives, yet a large proportion of the privileged few civil servants who have access to medical facilities cannot afford to pay for health care due to its rapidly escalating cost of medical care which has made civil servants not to wholly accept it (Ononokpo, 2010). Many low-income earners in the civil servnts regularly postponed medical treatment, resorted to self-treatment, or used alternatives provided by unregulated healers, spiritualist, and itinerant drug vendors, often with disastrous results (Ononokpo, 2010).This study is therefore being conducted to determine acceptance and satisfaction of National Health Insurance Scheme among Civil Servants in Nigeria. This will serve as a guide  for further recommendations to management in the scheme, and this will greatly help in organizing and managing the National health insurance scheme for better acceptability to the workforce.

1.2 STATEMENT OF THE PROBLEM

The establishment of the National Health Insurance Scheme as a health-care funding facility should excite all participants in the health-care industry, particularly civil officials in Jos. According to Dogo (2018), is of the view that the National Health Insurance Scheme, a health-care risk-sharing scheme, is the most likely solution to Nigeria's health-care disparity problem. As a result, the initiative was developed to assist spread the risks and lower health-care costs. Regrettably, the National Health Insurance System does not appear to have gained a much support, endorsement, and collaboration from public officials. Ononokpo (2010) The majority of civil servants are still hesitant to adopt the National Health Insurance Scheme program, according to research. They are all suspicious of the government's motives, intentions, and plans, he claims, especially now that they are aware that a monthly withdrawal from their salary will be made as their contribution to the "solidarity pool" that will be used to administer the system. Many public servants fail to access the National Health Insurance Scheme services, according to anecdotal reports and my experience as a health care provider with the National Health Insurance Scheme. Furthermore, there is a paucity of research on why many of these civil officials, who should be aware of the services and benefits, do not accept them because of the poor and low satisfaction level the derive from it. therefore the study centers on acceptance and satisfaction of national health insurance scheme services among civil servants in Nigeria

1.3     AIM AND OBJECTIVES

The general objective of this study will be to examine acceptance and satisfaction of national health insurance scheme services among civil servants in Nigeria. The specific objectives will be:

1) To determine the knowledge of civil servants on National health insurance scheme utilization among civil servants in Nigeria

2) To ascertain the relationship between acceptance and satisfaction of National health insurance scheme among civil servants in Jos

3) To recommend solution to the problems associated with assessing health services of National health insurance program  and how it  impacts on utilization by civil servants in Jos

1.4     RESEARCH QUESTIONS

1) What is the knowledge of civil servants on National health insurance scheme utilization among civil servants in Nigeria?

2)How is the relationship between acceptance and satisfaction of National health insurance scheme among civil servants in Jos?

3) What are solution to the problems associated with assessing health services of National health insurance program and how it  impact on utilization by civil servants in Jos?

1.5            HYPOTHESES

In order to enable the researcher to assess acceptance and satisfaction of national health insurance scheme services among civil servants in Nigeria, the following hypotheses will be tested:

H1:  there is no significant impact of the knowledge of civil servants on National health insurance scheme utilization among civil servants in Nigeria

H2: there is no relationship between acceptance and satisfaction of National health insurance scheme among civil servants in Jos

H3: the solution to the problems associated with assessing health services of National health insurance program has no impact on utilization by civil servants in Jos

1.6 SIGNIFICANCE OF THE STUDY

The findings of the study will reveal the acceptance and satisfaction of national health insurance scheme services among civil servants in Nigeria .The study will be relevant to the following

Civil servants : the study will show  If their views and perceptions are positive the civil servants will be encouraged to uphold them by the workers in the National Health Insurance Scheme. If their views are negative, there will be need for enlightenment of civil servants on the benefit of National Health Insurance Scheme by the workers in the National Health Insurance Scheme through special sensitization seminars. If the result indicates that the Civil Servants do not have enough satisfaction,

Government :  it will serve as a reason for the National Health Insurance Scheme 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 National Health Insurance Scheme.

Students: The will serve as a medium for further research, It is hoped that this study will serve as an available reference source and will help other researchers in this field; thus contributing to the existing literature

1.7 SCOPE OF THE STUDY

This study was delimited to all Civil Servants within Jos. The study will specifically be delimited to the determination of acceptance and satisfaction of National Health Insurance Scheme by Civil Servants in Jos. The study would cover the effect of National health insurance scheme in enhancing health care delivery. The study was carried in Jos .The geographical area is Plateau state.

1.8 OPERATIONAL DEFINITION OF TERMS

National Health Insurance Scheme: It is a nationwide health care financing system that seeks to provide affordable and accessible health care. It may be provided through a government sponsored social insurance programme, or from private insurance companies. Individuals or groups may be covered by the scheme through the payment of premiums or taxes to help protect them from high or unexpected healthcare expenses

CIVIL SERVANT: A civil servant, also known as public servant, is a person employed in the public sector by a government department or agency for public sector undertakings

SATISFACTION: Satisfaction is the act of fulfilling a need, desire, or appetite, or the feeling gained from such fulfillment

ACCEPTANCE: Acceptance in human psychology is a person's assent to the reality of a situation, recognizing a process or condition without attempting to change it or protest it.