CHAPTER ONE

INTRODUCTION

1.1.      BACKGROUND OF THE STUDY

To achieve equity in health care service delivery in Nigeria, after the inauguration of the National Health Insurance Scheme (NHIS) in 2005. The National Health Bill was passed in 2006 at the Nigerian National Health Conference attended by government representatives, international agencies and other key stakeholders in the health care sector is was found to be in line with the priority targets of the United Nations Sustainable Development Goals (UNSDG) on achieving ‘universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all’ (Target 3.8). National Health Insurance Scheme, 2009.

Similarly, the Act (Act No. 35 of 1999) establishing NHIS became operational in 2005 with the primary goal of improving the health status of Nigerian citizens as a significant co-factor in the national poverty eradication efforts. Nigeria has three levels of government: Federal (Central), state, and local government areas, and each level of government has its workers. Furthermore, the central government has institutions in each of the 36 states of the federation, with federal employees working in those institutions. With the formal sec-tor health insurance programme, which was designed to ensure that every federal government employee including their spouse and four biological children have access to good healthcare services and benefit from social health insurance programme, there was compulsory enrolment of all employees in the public sector as part of the formal sector programme of the scheme. Although the formal sector health insurance programme covers both federal and state workers, its implementation across all workers employed at the state agencies has not received much attention when compared to that of the federal employees since its inauguration in 2005. It is suggests that in spite of the health insurance programme is a federal government directive, especially for the public sector employees, there is a difference between the management of federal and state workers enrolled under the scheme. While federal workers are being managed by the federal government, all the state workers are managed by their respective state governments. Additionally, there are other programmes under the scheme, which were designed to cover other sections of the population, especially those who are not directly employees of the formal sector, such as self-employed persons in urban centres, rural dwellers, under-five children, the disabled, inmates and international travellers. These specific sections of the programme were called as the ‘urban self-employed health insurance’ programme, the ‘rural community’ programme, the ‘under-five children’ insurance programme, the ‘permanently disabled social health insurance’ programme, the ‘prison inmates’ program and the ‘international travel health insurance’ programme, respectively. However, the services for the beneficiaries of the federal civil service include only maternity care for up to 4 live births for every insured contributor/couple; provision of preventive care for registered employees such as immunization programme, post-natal care and family planning services, eye examination, as well as the opportunity to make consultations with specialists or referral for specialized investigations for medical/surgical reasons or other services such as diagnostic or physiotherapeutic services.

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