Table 2 Summary of empirical studies evaluating relevant equity issues for the NHIS (Nigeria)

Adeniyi, 2010[35]

Assess the knowledge & perceptions of Nigerian dentists to the NHIS

Access to health care

250 dentists employed in private and public dental clinics in Lagos State

61.1% had a fair knowledge of NHIS; 70.4% said NHIS will succeed if properly implemented; 76.6% believed NHIS will improve access to oral health services; 71.4% improve affordability, 68.3% improve availability of services. 74.4% said NHIS oral health care unacceptable.

The majority of the dentists involved in this study had some knowledge of the NHIS and were generally positively disposed towards the scheme and viewed it as a good idea.

Dienye, 2011[27]

Determine the pattern of hospital bill payment among rural surgical patients (2005–2009)

Access to health care; financing of health care

229 surgical patients in Ngo; 80% fish farmers & 86% of Christian religion

Multiple sources of finance were used: personal savings (71%), family (49%), organisations (31%), loans (16%), sale of property (30%). Only 3% had knowledge of NHIS, but 84% were willing to enrol.

Sources of finance for payment were multiple but the most common were personal savings & family members. A low knowledge of NHIS contrasted with high willingness to participate.

Ezeoke, 2012[4]

Investigate the costs of illness to households in different SES groups & geography; explore payment mechanisms used by different groups

Financing of health care

3,200 households from six communities in two states (Anambra and Enugu in southeast Nigeria)

Malaria was the most common illness. Average cost of transportation for malaria was 86 Naira ($0.6 US), & the total cost of treatment = 2,819.9 Naira ($20 US); drug costs contributed > 90%. OOP payment was the main method of payment. Treatment costs differed by geographic location and SES.

There is the need to substitute OOP spending with pre-payment mechanisms, with cross-subsidies from the rich to the poor & from the healthy to the unhealthy. This can be achieved by expanding NHIS for vulnerable groups, informal sector & scaling up CBHI schemes.

Ibiwoye, 2008[9]

Assess the contribution of NHIS to health care delivery; evaluate participation in and use of the NHIS

Access to health care

5,126 employees in the formal sector in Lagos State

11% saw cost as a barrier to membership; 36% had not heard of NHIS; NHIS users were 31.6% in 2006; Concern raised about HMOs & providers; gender, age, income, marital status, family size, education & occupation were significant explanatory variables of NHIS participation.

Low awareness affects NHIS participation and need to promote access, particularly among educated couples. Participation may be improved through compliance of compulsory enrolment and NHIS awareness campaigns.

Mohamed, 2011[38]

Determine enrollee satisfaction with provision under the NHIS and the factors influencing satisfaction

Access to health care

280 NHIS university staff enrolees of FSHIP who were insured for more than one year in Zaria-Nigeria

High satisfaction rate with NHIS = 42.1%. Marital status, general knowledge & awareness of contributions positively influenced clients’ satisfaction (p<0.05). Length of employment, salary income, hospital visits and duration of enrolment slightly influenced satisfaction.

The findings have assisted amendment re-prioritization of the operation of the NHIS. Future planning efforts should consider client satisfaction and the factors which influenced it on a regular basis.

Olugbenga-Bello, 2010[33]

Determine knowledge & attitude of civil servants in Osun state towards the NHIS

Access to health care; financing of health care

380 civil servants in the employment of Osun state government

40% were aware of NHIS through mainly TV/ billboards. None had good knowledge of the components of NHIS, 26.7% knew about its objectives, 30% knew about who should benefit from the scheme. OOP = 74.7% of health care spending. 0.3% have benefited from NHIS but 52.5% agreed to participate in the NHIS.

A significant association exists between willingness to participate in the NHIS scheme and awareness of methods of options of health care financing and awareness of NHIS.

Onwujekwe, 2011[37]

Examine socio-economic & geographic differences in health seeking & expenditures; inform interventions that reduce inequity in utilisation

Access to health care; financing of health care;

4,873 households (2,483 urban and 2,390 rural) in southeast Nigeria

Malaria & hypertension were major diseases requiring OPD and IPD. Providers: PMDs (41.1%), private hospitals (19.7%), pharmacies (16.4%). Rural dwellers & poorer SES groups mostly used low-level & informal providers. Monthly expenditure in urban area = 2444 Naira (US$20.4) & 2267 Naira (US$18.9) in rural area.

Inequities exist in use providers & expenditures on treatment. Reforms should decrease barriers to access public & formal health services & identify constraints which impede the equitable distribution and access for poor & rural dwellers.

Oyibo, 2011[34]

Assess the constraints and implications of OOP payments

Financing of health care

247 government employees in Abakaliki, Ebonyi State, south east Nigeria

62.8% reported illness in their in previous 4 weeks; 69% of these used OOP payments, 28.4% used NHIS, 2.6% borrowed money. 63.6% of OOP users had difficulties accessing quality health care; 47.7% used self- medication, 28.4% delayed seeking treatment, 17.1% used herbalists, 6.8% ignored illness.

Most government employees and their dependants in Abakaliki have difficulties in accessing quality health care services with OOP payments. This leads to negative health and access consequences. NHIS enrolees had little difficulty accessing health care.