Federal Civil Servants’ Perception and Involvement in the National Health Insurance Scheme in Ibadan


The Federal Government of Nigeria created the National Health Insurance Scheme as a social health insurance plan to supplement other funding sources for the healthcare industry and to increase access to healthcare for the vast majority of Nigerians. Currently, the majority of people enrolled in the Scheme are employed in the formal sector, and their experiences have varied. The purpose of this study is to ascertain how civil servants in Ibadan view and use the National Health Insurance Scheme.


Between October and November 2015, 273 civil personnel employed by the Federal Secretariat in Ikolaba participated in a descriptive cross-sectional research. Information on sociodemographic traits, awareness of and membership in the NHIS, perception of the NHIS, and health-seeking activity were gathered via an interviewer-administered questionnaire. The number of government servants registered or enrolled in the plan, or members of the scheme, was the definition of participation. A three-point Likert scale was used to collect perception-related data. At a significance threshold of five percent, descriptive statistics and chi-square tests were employed to analyse the data.


Males made up about 60.1% of the responders. The mean age of the participants was 39.7±9.1, and 85.0% of them were married. Mid-level cadre workers made up the majority of the respondents (65.2%), followed by senior-level workers (17.62%) and low-level cadre workers (17.6%). Of these, 88.9% completed their postsecondary education, compared to only 11.1% who finished their basic education. The average size of a household was 2.5±0.6. 95.2 percent of people were aware of the National Health Insurance Scheme, and 83.5% of people had signed up for it. A little over half of the participants joined the programme due to its low cost and accessibility. Awareness, education level, and familiarity with the NHIS were significantly correlated with respondents’ scheme registration. 87.3 percent of respondents said that NHIS is a superior

In summary:

While participation in health insurance was high, federal officials’ perceptions of it varied. Enacting pertinent interventions is necessary to eliminate obstacles to utilising and executing the programme.


Any nation’s ability to prosper is based on the health of its people. As a result, every nation looking to grow economically should work to enhance the health of its people so that they can support that growth.1. As the principal driver of growth and development in any nation, the health sector plays a vital role in providing social services to its burgeoning population.

However, tax income, personal expenses, donations, and health insurance all go into paying for healthcare in Nigeria.2. Even in comparison to other African nations, Nigeria spends comparatively less on health care.2. Between 1998 and 2000, the proportion of total health expenditure (THE) to GDP was less than 5%, lagging behind developing nations like Kenya (5.3%), Zambia (6.2%), Tanzania (6.8%), Malawi (7.27%), and South Africa (7.5%).3. It has been determined that a few of the financing systems for health care have not been successful due to a lack of political will, uncertain economic conditions, corruption, and limited institutional ability.4

Moreover, insurance functions as a risk transfer mechanism in which the insured pays a third party (the insurer) small periodic payments known as premiums in exchange for benefit packages that are paid out in the case of a predetermined occurrence.5. Thus, pooling of cash and health risks is a component of health insurance. Nigeria’s National Health Insurance Scheme (NHIS) was created to give employees the bare minimum of financial protection from unfavorable losses brought on by illness, old age, unemployment, and other mishaps. It is based on a pre-payment structure in which the employee can utilize the plan whenever they are sick and the employer and employee both contribute to the plan.5. Services for new enrollees began later in 2005, although the program was formally introduced on June 6, 2005. 2013 saw the issuance of almost four million identity cards, the accreditation and registration of 62 HMOs (Health Maintenance Organizations), and the processing of further applications, according to Osae-Brown. Without a doubt, the NHIS is a vital tool for raising the nation’s low health indices and lowering out-of-pocket costs for high-quality medical treatment. Approximately five million Nigerians have easy access to healthcare thanks to the NHIS since its establishment.Six The NHIS insurance packages are extremely extensive, covering almost all of the subscribers’ medical requirements, including consultations, prescription medications, consumables, and other minor surgeries.

Without a doubt, the nation’s economic progress greatly benefits from the work of civil officials. Providing civil servants with high-quality healthcare should be their first concern in order to improve the public service workforce and the effective and efficient delivery of public services.sixteen Given its alluring packages, the NHIS would be extremely valuable to federal servants. Diagnostic tests, medications, medical supplies, and outpatient care are a few of its packages. In addition, fifteen cumulative days of free inpatient care in a typical ward per year are included.

But when it comes to an insurance-based health system, Nigerians lack the necessary skills, information, and awareness.7,43–44 The efficacy of NHIS has been adversely affected by the persistently high levels of corruption, lack of accountability, and transparency in the nation.7 Getting access to inexpensive, high-quality healthcare is still a major issue. This is due to the chronic lack of workers in the health sector, antiquated and insufficient medical equipment, limited funding, inconsistent health policy, and corruption.8–11. Other barriers to the provision of high-quality healthcare in Nigeria include the consumer’s inability to pay for services, gender bias resulting from cultural or religious convictions, and unequal access to healthcare facilities in urban and rural areas.10. Consequently, the purpose of this study was to ascertain how federal civil officials in Ibadan felt about and engaged with the NHIS.


Design of Study:

A cross-sectional descriptive study was carried out in October and November of 2015.

Site of Study:

Civil servants of the Federal Secretariat Complex in Ikolaba, Ibadan, Nigeria, participated in this study. There are 853 employees working across 13 departments and 8 ministries within the complex (as of September 2015).

Sample Quantity:

At a 5% level of significance and a 20% prevalence of individuals using formal healthcare providers, a minimum sample size of 246 was determined.

Method of Sampling:

Respondents were chosen using a methodical random sampling process. Out of the seven ministries and fifteen agencies in the secretariat, three ministries and six agencies were chosen at random through voting. There were 425 people working for the ministries and agencies that were chosen. Following a proportionate distribution of the necessary respondents across the various ministries based on the number of employees in each, the necessary respondents were subsequently chosen at regular intervals from the sampling fraction. By dividing the required number of respondents in the ministry or agency by the total number of employees there, the sampling percentage was determined.

Criteria for Inclusion and Exclusion:

All federal government servants employed by the Secretariat for a minimum of two years at the time of the study were included in this analysis. However, no temporary or contract employees working for any of the ministries or agencies were included in the study.

Depending on the grade level of their salaries, the respondents were split into three groups. personnel with a pay grade level of 6 or lower were classified as junior cadre, whilst those with a salary grade level of 7 to 10 were classified as mid-level personnel. Lastly, senior workers were defined as those with pay grade levels more than 10.

The UI/UCH Ethical Review Committee granted ethical clearance for the study (Reference number: UI/EC/15/0415). The heads of departments gave permission to distribute the questionnaires. Before the surveys were distributed, participants gave their informed consent. Participation was entirely optional, and the information gathered was kept very private.

Tool for Gathering Data:

The study employed a self-administered, semi-structured questionnaire as the data collection tool. While some of the questions were open-ended, the majority had pre-codes. Four sections made up the questionnaire: Eight questions in Section A assessed the respondents’ sociodemographic traits; twelve questions in Section B asked about the respondents’ knowledge of and enrollment in the National Health Insurance Scheme; six questions in Section C asked about the respondents’ opinions of the NHIS; and five questions in Section D asked about the respondents’ actions when seeking medical attention. After conducting a pre-test with civil personnel at the state secretariat in Agodi, Ibadan, unclear questions were reworded.


Forty-one (15.0%) of the respondents were unmarried, and about three out of every five were men (60.1%). Table 11 indicates that the majority of respondents (178, 65.2%) were mid-level cadre workers, with over half (50.5%) having completed tertiary education.

260 (95.2%) of the respondents self-reported as being aware of the NHIS, indicating a high level of self-reported awareness among them. Merely 13 participants stated that they were not aware of the program. When asked where they got the most of their information on the Scheme, the most people said radio and television shows (29.3%). Additional information was obtained from a health professional (25.6%), another Plan enrollee (25.3%), and a Scheme management (16.5%).

When asked how they felt about NHIS, most of the 260 enrolled respondents (87.3%) said that they thought it was a better way to pay for healthcare than out-of-pocket expenses (OOPE). Merely 14 participants, or 5.5%, thought that OOPE was a superior payment alternative for NHIS. Nonetheless, nine (3.5%) of the respondents thought that even with proper implementation, NHIS will fail. Also, 233 (89.6%) respondents thought the Scheme will succeed if implemented properly, while 19 (6.9%) were neutral. Regarding their opinion of the NHIS’s capacity to provide better healthcare access, protection from debt and other types of catastrophic health expenditure (CHE), and enhanced quality and affordability of healthcare services, a similar pattern of answers was noted.

In terms of their involvement in the NHIS, the majority of respondents (83.5%) reported being enrolled. The primary motivators for the majority of participants (50.5%) to enroll in the Scheme were the free medical care (27.8%) and the reasonably priced health care services. Poor knowledge of the Scheme (35.3%) was cited as the main reason people did not participate in it, closely followed by their inability to pay the premiums (29.4%). Only 24.4% of the respondents reported having difficulty registering for the NHIS, with the most frequent obstacles being laborious registration procedures (53.1%) and identity card issuing delays (35.9%).



Leave a Comment