SATISFACTION WITH THE NATIONAL HEALTH INSURANCE SCHEME PROVIDER SERVICES AMONG CIVIL SERVANTS AT THE FEDERAL SECRETARIAT, IBADAN, NIGERIA.

Abstract

The National Health Insurance Scheme (NHIS) was introduced in Nigeria to support health care financing in order to improve access to health care. The first phase is targeted at workers in the civil service. End users’ satisfaction is an important determinant of success of health programmes which should be routinely assessed for identification of areas of improvement. This study was therefore designed to assess civil servants’ satisfaction with NHIS. A cross sectional study was conducted. All consented staff at the Federal Secretariat, Ibadan who have enrolled in NHIS for at least one year were recruited for the survey. A total of 417 respondents were recruited for this study. A semi-structured questionnaire was used to obtain data on socio-demographic characteristics, experiences with NHIS and satisfaction with health care services. The NHIS service areas such as drug availability and waiting time were rated using a 5-point likert scale. Overall satisfaction was a composite score of NHIS service areas. Satisfaction with Health Care Provider (HCP) services was determined by scoring each domain and finding a cut off point. Scores below this cut off mark were classified as not satisfied and scores ≥ cut off were classified as satisfied. The satisfaction ratings for different aspects of NHIS which includes enrollee’s choice of HCP and registration/enrolment ranged from 1 to 5 and was dichotomized such that those that scored between < were classified as not satisfied and those that scored between 3 and 5 were classified as satisfied. Chi-square test and binary logistic regression were used to analyze data at 5% level of significance. Mean age of respondents was 42.5 ± 8.0 years, 53.0% were males, 88.3% were married and 88.0% had tertiary education. Majority (80.0%) had to wait for 7 - 24 months after registration to receive NHIS number and card. Sixty-three percent reported having difficulty registering their dependants, 88.0% had utilized the NHIS services within the last one year preceding the study. Of these, 38.0% had changed their HCP due to poor services. Mean satisfaction score for NHIS service areas was 89.8 ± 8.9. Fifty-two percent of the respondents were satisfied with staff attitude, 55.6% with drug availability, 56.2% with services provided, and 78.0% with waiting time. Overall, 55.3% of the respondents were satisfied with the NHIS service areas provided by their HCPs. About 62.0% rated the copayment plan, change of HCP processes (55.4%), the registration/enrolment processes (54.7%) and range of services covered (50.5%) to be poor while 66.0% rated the choice of HCP and referral system (58.7%) to be good. The satisfaction with NHIS service areas was significantly higher among those that used public facilities (OR=1.9, p=0.026), those who registered at the inception of the programme (OR=3.1, p=0.019), and those in grade level 11 and above (OR=2.8, p=0.008). About half of the respondents were satisfied with the services they had received. Areas of dissatisfaction included co-payment system and range of services covered. Efforts should be made to address areas of dissatisfaction to encourage continued participation and utilization of services.