Barriers to Enrolment into Health Insurance Schemes in Nigeria: the case of Niger State Contributory Health Insurance Scheme

Abstract

Niger State government has keyed into the health insurance program of the federal government since 2019, with the establishment of the Niger State Health Insurance Scheme. Although the scheme has beautiful mission for the formal and the informal sector workers as well as the students in tertiary institutions and the vulnerable groups, it is yet to enjoy reasonable patronage. Studies on barriers to enrolment into health insurance were mostly conducted in matured health insurance settings, where barriers to enrolment do with operational concerns. It is not clear whether operational concerns may affect enrolment in Niger State where the health insurance scheme is at the take-off stage. Using qualitative research design to explore the enrolment barriers, this study has drawn a sample of 22 respondents across the major tribes, religions, enrolment category and senatorial zones of the state. Four enrolment officers were also part of the respondents. An in-depth interview was conducted on the respondent and the results were analysed in themes. The findings of the study showed that lack of trust in anything government is the major barrier to enrolment among the public sector workers due to their prior experiences of failed schemes run by government. However, inadequate sensitization about the requirements, procedures for enrolment, cost and benefits of the scheme were the barriers to enrolment among the informal and the private sector workers. The enrolment of the vulnerable groups is undermined by the lack of social register from where the list of the qualified people would be extracted. In addition, the lack of National Identification Number, which is the pre-requisite for enrolment, deters enrolment of the vulnerable groups. The problem of insecurity in the state also affects outreach and enrolment. Necessary suggestions are given to the government.