CHAPTER ONE

INTRODUCTION

1.1 Background of the study

This study evaluates one of the cardinal objectives of good governance which is to have effective healthcare delivery system put in place for the entire citizens. A healthy nation is a wealthy nation because of the absence of debilitating diseases and epidemics in such a country, which, along with hunger and squalor, impoverishes the citizenry (Nwatu, 2000:12).

The national health insurance scheme (NHIS) functions as a social health insurance program designed by the federal government of Nigeria to improve every services related to financial health sector, and to improve access of health care for the majority of Nigeria. The evolution of the National Health Insurance scheme details back to 1962, when the need for health insurance in the provision of health care to Nigeria citizen was first announced. Furthermore, the introduction of the structural adjustment program in 1986 adversely affected health allocation and other factors that led to the introduction of the national health insurance scheme. This general poor stated of the nation’s health care services is giving the government a lot of concern. The concept of social health insurance was first mooted in 1962 by Heuvi committee, which passed the proposal through the Lagos health bill. Unfortunately it was truncated in 1985, Dr. Emmanuel Usman, the minister of health set up a committee on national health review led by Mr. L. Ligailu.  At its 42nd meeting, the national council on health (NCH) approved the NIS to ensure full private sector participation. This model ensured the introduction of health maintenance organization (HMO) and financial managers of the scheme. On October 15th the national health insurance scheme was finally launched.

In the developed world, insurance in one form or the other is a veritable and sustainable tool for financing healthcare. The National Health Insurance (NHIS) was launched in Nigerian on October 15, 1997 and was passed into law in May 1999. The original scheme has been modified to include healthcare for less privileged persons in the country (FMH, 1998). According to the World Health Organization (WHO) in 2005, Nigeria was ranked 197th out of 2000 nations; life expectancy was put at 48 years for male and 50 years for female while healthy life expectancy (HALE) for both sexes was put at 42 years. Nigeria accounts for 10% of global maternal mortality with 59,000 women dying annually from pregnancy and child birth; only 39% are delivered by skilled health professionals. In order to provide equitable distribution of health, the NHIS was introduced in Nigeria The need for the establishment of the scheme was informed by the general poor state of the nation’s healthcare services, excessive dependence and pressure on the government’s provision of health facilities, dwindling funding of health care in the face of rising cost, poor integration of private health facilities in the nation’s healthcare delivery system and overwhelming dependence on out-of-pocket expenses to purchase health. Like any other insurance scheme, the premium for the NHIS is the amount charged by the insurance compared with the promise to pay for any eventual “covered medical treatment” for the designated “coverage”. Consequently health insurance makes it possible to substitute a small but certain cost for a larger but uncertain loss (chain) under an arrangement in which the healthy majority compensate for the risks and costs of the unfortunate ill minority. The NHIS currently represents 15% of one’s basic salary. The employer is to pay 10% while the employee contributes 5% of his/her basic salary to enjoy healthcare benefits. The contribution made by the insured person entitles his/her spouse and four children under the age of 18 to full health benefits (FMH 2005) NHIS was designed to provide minimum economic security for workers with regard to unfavorable losses resulting from accidental injury, sickness, old age unemployment and premature death of family wage earner. NHIS is made compulsory because the government based on past experiences predicted that some citizens cannot engage in the scheme and the government also has the duty to protect the general welfare of all citizens (Ibiwoye and Adedeke, 2007). It is also the government’s belief that NHIS will help to break the vicious cycle of poverty in the country. It is also a form of social support for workers (Jutting, 2003). There is lack of health care coverage and little equity. Access to healthcare is limited and most Nigerians are unable to pay for health services and health facilities are far from being equitably distributed. All these contributed to the limitation in health services (Samin and Awe, 2009). The available health services are very expensive and the common man cannot afford it; only the privileged few can get access to good health. This study aims at assessing the level of knowledge and attitude of civil servants resident in Nigeria to NHIS.