Willingness to Participate in the National Health Insurance Scheme among Staff of a Higher Academic Institution in South-West Nigeria
Main Article Content
Abstract
Background: The National Health Insurance Scheme (NHIS), a healthcare financing policy to ensure universal health coverage and reduce out-of-pocket health expenditures is presently under-utilized by the Nigerian population. This study assessed the willingness to participate in NHIS among staff of University of Medical Sciences Ondo (UNIMED), Ondo, Nigeria.
Methods: This was a cross-sectional study. A structured pre-tested, self-administered questionnaire was used to elicit information from 280 respondents selected by multistage sampling technique. Data was analysed using IBM Statistical Package for Social Science (SPSS) Version 25. Chi-square test was used to assess association between willingness to participate in NHIS and other variables, with the significant level set at <0.05.
Results: Two hundred and sixty-six respondents completed the questionnaire, giving a response rate of 95%. Slightly more than half of the respondents were males (52.6%) and within the age range of 31-40 years (53.0%). The largest proportion were administrative staff (43.2%). Majority (88%) of the respondents were aware of NHIS but only a few (19.5%) were covered by the scheme. Two hundred and three (76.3%) of the staff were willing to participate in NHIS and among these 92% were willing to contribute to the scheme. No statistically significant relationship was found between income, educational status, participant’s awareness of NHIS and their willingness to participate in NHIS.
Conclusions: In order to improve participation in the NHIS by staff of UNIMED, Ondo, advocacy and mass sensitization campaign across the institution on the roles and benefits of participating in the NHIS is recommended.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to editor@tnhjph.com.
How to Cite
References
1. NHIS. National Health Insurance Scheme: “Operational Guidelines”. 2001. National NHIS, Abuja: Vast Communications Publishers.
2. NHIA. National Health Insurance Authority Act of the Federal Republic of Nigeria. 2022. Available from: https://www.nhis.gov.ng/download/nhia-act-2022/ (Last accessed July 27, 2025).
3. Omotowo IB, Ezeoke UE, Obi IE, Uzochukwu BS, Agunwa CC, Eke CB, et al. Household perceptions, willingness to pay, benefit package preferences, health system readiness for National Health Insurance scheme in southern Nigeria. 2016. Health. 8(14):1630-44.
4. World Health Organization. Health financing. Monitoring Sustainable Development Goals-Indicators 3.8.2. 2018. Available online at: https://www.who.int/health_financing/topics/financial-protection/monitoring-sdg/en/ (Last accessed October 17, 2025).
5. Bashar JM, Hadiza S, Ugochi OJ, Muhammad LS, Olufemi A, Eberechi U et al. Charting the path to the implementation of universal health coverage policy in Nigeria through the lens of Delphi methodology. BMC Health Serv Res. 2025. 25, 45 (2025) https://doi.org/10.1186/s12913-024-12201-7
6. NHIS. National Health Insurance Scheme Annual Report. 2018. Abuja: Nigerian National Health Insurance Scheme.
7. NHIS. National Health Insurance Scheme Annual Report. 2019. Abuja: Nigerian National Health Insurance Scheme.
8. Uzochukwu BS, Ughasoro MD, Etiaba E, Okwuosa C, Envuladu E, Onwujekwe OE. Health care financing in Nigeria: Implications for achieving universal health coverage. Nigerian journal of clinical practice. 2015; 18(4):437-44.
9. Ajayi PO, Ibirongbe DO, Ipinnimo TM, Solomon OO, Ibikunle AI, and Obiagwu AE. The Prevalence of Household Catastrophic Health Expenditure in Nigeria: A Rural-Urban Comparison. Journal of Health and Medical Sciences. 2021; 4(2):94-105.
10. World Health Organization. Global Health Expenditure Database. 2023. Available online at: https://apps.who.int/nha/database/Select/Indicators/en. (Last accessed October 10, 2025).
11. Sanusi RA and Awe AT. An Assessment of Awareness Level of National Health Insurance Scheme among Health Care Consumers in Oyo State, Nigeria’. The Social Science. 2019; 2:143-148.
12. UNIMED. University Facts. 2022. Available online at: https://www.unimed.edu.ng/establishment-facts (Last assessed October 20, 2025)
13. Araoye MO. Research Methodology with Statistics for Health and Social Sciences. 2004. Ilorin, Nigeria: Nathadex Publishers; 117-20.
14. Osunde NR, Olorunfemi O, Oduyemi RO. Awareness, willingness, and challenges of the informal sector toward state National Health Insurance Services in Benin City, Nigeria. MGM Journal of Medical Sciences. 2023. 10(1): 30-37. Doi: 10.4103/mgmj.mgmj_191_22
15. Kibret, G. D., Leshargie, C. T., Wagnew, F., et al. Willingness to join community-based health insurance and its determinants in East Gojjam Zone, Northwest Ethiopia. BMC Research Notes, 2019; 12, 31.
16. Akinyemi OO, Owopetu OF, Agbejule IO. National Health Insurance Scheme: Perception and Participation of Federal Civil Servant in Ibadan. Annals of Ibadan postgraduate medicine. 2021; 19(1): 49-55.
17. Aderibigbe SA, Aganaba D, Osagbemi GK, Aderibigbe AA. Knowledge, Practice and Willingness to Participate in Community Health Insurance Scheme among Households in Nigerian Capital City. Sudan Journal of Medical Sciences. 2017. 12(1): 9-18. DOI 10.18502/sjms.v12i1.854
18. Adibe MO, Udeogaranya PO, Ubaka CM. Awareness of National Health Insurance Scheme (NHIS) activities among employees of a Nigerian university. International Journal of Drug Development and Research. 2011; 3(4): 78-85.
19. Adekunle W, Vincent O. Analysing the determinants of healthcare insurance uptake in Nigeria. BMC Health Serv. 2025. Res 25, 1310. https://doi.org/10.1186/s12913-025-13422-0
20. Al-Hanawi MK, Vaidya K, Alsharqi O. Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia: A Cross-sectional Stated Preference Approach. Appl Health Econ Health Policy. 2018; 16: 259–271. https://doi.org/10.1007/s40258-017-0366-2
21. Akwaowo CD, Umoh I, Motilewa O, Akpan B, Umoh E, Frank E et al. Willingness to Pay for a Contributory Social Health Insurance Scheme: A Survey of Rural Residents in Akwa Ibom State, Nigeria. Frontiers in public health. 2021; 9: 654362. https://doi.org/10.3389/fpubh.2021.654362
22. Phiri, I. & Masanjala, W. Willingness to pay for micro health insurance in Malawi. In H.-J. Rösner, G. Leppert, P. Degens, & L.-M. Ouedraogo (Eds.), Handbook of Micro Health Insurance in Africa. 2012; (pp. 285–308). Berlin, Germany: Lit Verlag.
23. Adams R, Chou YJ, Pu C. Willingness to Participate and Pay for a Proposed National Health Insurance in St. Vincent and the Grenadines: A Cross-sectional Contingent Valuation Approach. BMC Health Serv Res. 2015; 15: 148. https://doi.org/10.1186/s12913-015-0806-3
24. Njie H, Wangen KR, Chola L, Gopinathan U, Mdala I, Sundby JS, et al. Willingness to pay for a National Health Insurance Scheme in the Gambia: a contingent valuation study. Health Policy Plan. 2023; 38(1): 61-73.
25. Oyekale, A. S. (2012). Factors Influencing Households' Willingness to Pay for National Health Insurance Scheme in Osun State, Nigeria. Studies on Ethno-Medicine, 6(3), 167–172.
26. Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health Behavior: Theory, Research, and Practice (5th ed.). Jossey-Bass.