Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site study
Abstract Background In efforts to advance universal healthcare coverage (UHC) in Nigeria, the federal government empowered sub-national entities such as states to develop and implement their respective state-supported health insurance schemes (SSHIS). This study assessed the coverage and predictors...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-06-01
|
| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-025-23329-4 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850224357394087936 |
|---|---|
| author | Fortune Benjamin Effiong Roseline Dzekem Dine Ibrahim Adebayo Hassan Dimeji Abdulsobur Olawuyi Idongesit Kokoabasi Isong David Ayobami Adewole |
| author_facet | Fortune Benjamin Effiong Roseline Dzekem Dine Ibrahim Adebayo Hassan Dimeji Abdulsobur Olawuyi Idongesit Kokoabasi Isong David Ayobami Adewole |
| author_sort | Fortune Benjamin Effiong |
| collection | DOAJ |
| description | Abstract Background In efforts to advance universal healthcare coverage (UHC) in Nigeria, the federal government empowered sub-national entities such as states to develop and implement their respective state-supported health insurance schemes (SSHIS). This study assessed the coverage and predictors of enrollment in the SSHIS in six Nigerian states. Methods This study used a quantitative cross-sectional design. Respondents were recruited across six Nigerian states with operational SSHIS, corresponding to the country’s six geopolitical zones. These include the Cross River, Enugu, Oyo, Kwara, Sokoto, and Taraba states, representing the South-South, South-East, South-West, North-Central, North-West, and North-East zones respectively. Data were collected from community members in congregate settings such as markets, churches/mosques, schools, bus stations/parks, and healthcare facilities. Descriptive, bivariate, and multivariate analyses were conducted using SPSS version 25. Results The number of study respondents was 3732. The greater majority of the respondents were self-employed 1855 (49.7%) and were living with an average monthly income of < 10,000 naira 1175 (31.5%). Coverage of the state health insurance was highest in the North-Central Kwara State 326 (37.3%), but lowest in the South-Eastern Enugu State 6 (1%). Among beneficiaries, overall satisfaction with the scheme was highest in Oyo State 73 (77.7%), but lowest in Cross River State 16 (32.7%). After adjusting for confounders, several covariates were identified as decreasing the odds of enrolling into the schemes; however, lack of awareness about the scheme was most significant across all the six states. Conclusion Low coverage due to poor awareness, financial barriers, and enrollee dissatisfaction currently affect the SSHIS in Nigeria. To improve enrollment and sustainability, nationwide educational campaigns and consolidation of health insurance schemes are recommended. |
| format | Article |
| id | doaj-art-2c589c19d70f4e998aaad46bdbd21546 |
| institution | OA Journals |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj-art-2c589c19d70f4e998aaad46bdbd215462025-08-20T02:05:39ZengBMCBMC Public Health1471-24582025-06-0125111310.1186/s12889-025-23329-4Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site studyFortune Benjamin Effiong0Roseline Dzekem Dine1Ibrahim Adebayo Hassan2Dimeji Abdulsobur Olawuyi3Idongesit Kokoabasi Isong4David Ayobami Adewole5Medical Laboratory Services, University of Calabar Teaching Hospital (UCTH)Department of Community Engagement and Social SciencesFaculty of Pharmacy, Obafemi Awolowo UniversityFaculty of Clinical Sciences, College of Medicine, University of IbadanFaculty of Medical Laboratory Science, University of CalabarDepartment of Health Policy and Management, College of Medicine, University of IbadanAbstract Background In efforts to advance universal healthcare coverage (UHC) in Nigeria, the federal government empowered sub-national entities such as states to develop and implement their respective state-supported health insurance schemes (SSHIS). This study assessed the coverage and predictors of enrollment in the SSHIS in six Nigerian states. Methods This study used a quantitative cross-sectional design. Respondents were recruited across six Nigerian states with operational SSHIS, corresponding to the country’s six geopolitical zones. These include the Cross River, Enugu, Oyo, Kwara, Sokoto, and Taraba states, representing the South-South, South-East, South-West, North-Central, North-West, and North-East zones respectively. Data were collected from community members in congregate settings such as markets, churches/mosques, schools, bus stations/parks, and healthcare facilities. Descriptive, bivariate, and multivariate analyses were conducted using SPSS version 25. Results The number of study respondents was 3732. The greater majority of the respondents were self-employed 1855 (49.7%) and were living with an average monthly income of < 10,000 naira 1175 (31.5%). Coverage of the state health insurance was highest in the North-Central Kwara State 326 (37.3%), but lowest in the South-Eastern Enugu State 6 (1%). Among beneficiaries, overall satisfaction with the scheme was highest in Oyo State 73 (77.7%), but lowest in Cross River State 16 (32.7%). After adjusting for confounders, several covariates were identified as decreasing the odds of enrolling into the schemes; however, lack of awareness about the scheme was most significant across all the six states. Conclusion Low coverage due to poor awareness, financial barriers, and enrollee dissatisfaction currently affect the SSHIS in Nigeria. To improve enrollment and sustainability, nationwide educational campaigns and consolidation of health insurance schemes are recommended.https://doi.org/10.1186/s12889-025-23329-4Health insuranceOut-of-pocketSSHISStatesUHC, Nigeria |
| spellingShingle | Fortune Benjamin Effiong Roseline Dzekem Dine Ibrahim Adebayo Hassan Dimeji Abdulsobur Olawuyi Idongesit Kokoabasi Isong David Ayobami Adewole Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site study BMC Public Health Health insurance Out-of-pocket SSHIS States UHC, Nigeria |
| title | Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site study |
| title_full | Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site study |
| title_fullStr | Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site study |
| title_full_unstemmed | Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site study |
| title_short | Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site study |
| title_sort | coverage and predictors of enrollment in the state supported health insurance schemes in nigeria a quantitative multi site study |
| topic | Health insurance Out-of-pocket SSHIS States UHC, Nigeria |
| url | https://doi.org/10.1186/s12889-025-23329-4 |
| work_keys_str_mv | AT fortunebenjamineffiong coverageandpredictorsofenrollmentinthestatesupportedhealthinsuranceschemesinnigeriaaquantitativemultisitestudy AT roselinedzekemdine coverageandpredictorsofenrollmentinthestatesupportedhealthinsuranceschemesinnigeriaaquantitativemultisitestudy AT ibrahimadebayohassan coverageandpredictorsofenrollmentinthestatesupportedhealthinsuranceschemesinnigeriaaquantitativemultisitestudy AT dimejiabdulsoburolawuyi coverageandpredictorsofenrollmentinthestatesupportedhealthinsuranceschemesinnigeriaaquantitativemultisitestudy AT idongesitkokoabasiisong coverageandpredictorsofenrollmentinthestatesupportedhealthinsuranceschemesinnigeriaaquantitativemultisitestudy AT davidayobamiadewole coverageandpredictorsofenrollmentinthestatesupportedhealthinsuranceschemesinnigeriaaquantitativemultisitestudy |