ABSTRACT
The central theme of this study is healthcare financing with focus on the Social Health Insurance system (National Health Insurance Scheme - NHIS) for Nigeria. Like other developing countries of the world, the Nigerian government has been constrained in its effort to provide free healthcare services to its teeming population largely as a result of the global economic recession, Structural Adjustment Programme (SAP), IMF/World Bank imposed conditionalities of reduced public spending on social services (including health), and devaluation of the naira. These, coupled with a rapid population growth and political instability have resulted (over years) in a gradual decline in government expenditure on healthcare and an attendant deterioration of public healthcare services in terms of both quality and quantity. This has reflected visibly on the health indices for Nigeria as evidenced by the high Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR) and the life expectancy at birth (55yrs). In response to this, the Nigerian government was compelled to review its policy on - healthcare financing and consequently introduced user charges in public health facilities in order to generate revenue for the health sector. Unfortunately, this effort failed, as the government could not (for equity reasons) fix user charges at levels high enough to generate substantial revenue for the sector. Subsequently, a national health insurance system for Nigeria was seen and considered as a viable option to bring back to life our already bastardized healthcare system, thus the birth of the National Health Insurance Scheme (NHIS). The NHIS was signed into law (May, 1999) and preparatory to take off, has embarked on public mobilization and enlightenment in order to create awareness on the scheme. The NHIS is voluntary by design and has as major stakeholders, employers and employees of the organized formal sector whose level of awareness, opinion and attitude towards it are major determinants of success. The Nigerian civil servants are probably the most important stakeholders, so also is their opinion and attitude towards the scheme. It is in view of this that this study set out to assess the knowledge, opinion and attitude of civil servants in Sokoto State towards the scheme. It took the form of a descriptive, cross - sectional intervention study employing focused group discussions and the Intensive Market Research Technique. The first chapter gives an introduction to the subject and the National Health Insurance Scheme. It also tries to justify the relevance of the study. Chapter two gives a theoretical discussion of the various forms of healthcare financing with emphasis on social health insurance. It reviewed the blistery of NHIS and described its structure and operation. Chapter three is a description of the methodology while chapter four offers the results as obtained in the study Chapter five is a discussion of the results, ending with a conclusion and recommendation. By way of focused group discussions, the study revealed a very low level of knowledge (awareness) on the NHIS among the civil servants in Sokoto State. Following an intervention with education materials aimed at creating awareness on the NHIS among these civil servants, the Intensive Market Research Technique was employed to assess their opinion and attitude towards the scheme. The outcome revealed a very high receptivity and acceptability of the scheme among them. It also identified, grade level and family size as potent factors which may shape the opinion and attitude of civil servants towards the scheme.