EFFECT OF HEALTH INSURANCE EDUCATION ON KNOWLEDGE, ATTITUDE AND WILLINGNESS TO PARTICIPATE IN NATIONAL HEALTH INSURANCE SCHEME AMONG CIVIL SERVANTS IN TWO SOUTH-WEST STATES OF NIGERIA

Abstract

Introduction: For many years, the health sector in Nigeria had been characterised by different challenges which limited access to healthcare services and facilities within urban and rural areas. The NHIS was launched in 2005 to correct these inadequacies. Nevertheless, after almost ten years of the scheme, only 5.3 million Nigerians who are federal civil servants have been enlisted. This trend may have been as a result of the paucity of information regarding the objectives, operational guidelines and benefits of the scheme. Therefore, this study investigated the effect of health insurance education on knowledge, attitude and willingness to participate in the NHIS among civil servants in Oyo and Ogun States.
Methodology: A quasi-experimental study was conducted involving two groups: the intervention group (Ogun State) and the control group (Oyo State). A total of 840 civil servants were approached in both groups but 802 consented and participated at both stages of the study, giving a response rate of 95.5%; 402 (50.1%) were in the intervention group while 400 (49.9%) were in the control group. This sample size was used during the baseline and post-intervention surveys for the same respondents and there was no loss to follow up. The study was conducted using qualitative and quantitative methods in the two stages of the study. In the first stage, a focused group discussion guide was used to obtain information from the civil servants and a pre-tested questionnaire was administered to both the control and intervention groups using a multistage sampling technique. Baseline and post-intervention data were compared to estimate statistical differences. The intervention (stage 2) consisted of a 2-day workshop for groups of 50 civil servants in each of the nine groups in the intervention group for a period of two weeks. The control group were not given any health education. Stage 3 involved collection of information using the same questionnaire from the intervention and control civil servants after 3 months. Data were analysed using Statistical Package for the Social Sciences (SPSS version 15). Frequencies were generated and appropriate statistical tests used to test for associations. Statistical significance was set at 5%. Qualitative data was analysed along thematic areas.
Results: A greater majority of the FGD participants had heard about the NHIS but many did not know much about it and had a negative attitude towards it. While respondents among senior staff were willing to participate in the scheme, it was observed that the junior staff were not willing because of the fear of misappropriation of their deductions and distrust regarding government’s
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intention. The mean age of the respondents from intervention group was 32.3 (+ 7.0) compared to the mean age of 34.0 (+ 9.0) among the respondents in the control group (p = 0.002). Majority of the respondents at the pre-intervention stage have heard about the NHIS. This was slightly higher among the control group (66.3%) compared to the intervention group (64.7%). A greater proportion of respondents in the intervention group (53.5%) and in the control group (74.7%) heard about the NHIS from radio/television sources.
Respondents in the intervention (20.6%) and control (20.5%) groups understood what NHIS operational guidelines were at the baseline survey. After the intervention, the number increased significantly for those in the intervention group to 41% (P<0.001) while there was only a marginal increase for the control group to 21% (P=0.288). Regarding the knowledge of NHIS objectives, respondents with good knowledge in the intervention group increased from 11.2% to 62.9% at the pre- and post-intervention surveys respectively while respondents in the control group recorded a slight increase from 23.3% to 24% at the pre- and post-intervention surveys respectively. Also on the knowledge of NHIS benefit packages, respondents in the intervention group who had good knowledge improved significantly from 1.2% to 32.6% (p<0.001) at the pre- and post-intervention respectively. In contrast, respondents in the control group who had good knowledge of NHIS improved from just 3.5% to 4.0% (p=0.153). The overall mean knowledge score in the intervention group improved from 5.4+3.4 to 9.0+3.8 (t-test=-29.24,p<0.001) compared to the control group from 4.1+4.3 to 4.2+4.0 (t-test -1.28, p=0.203). The mean attitude score to the scheme varied from 1.93+2.7 to 3.68+3.4 in the intervention group compared to 1.76 +-3.4 to 1.56+2.8 in the control group at the pre- intervention and post-intervention stages respectively. Willingness to participate in NHIS increased from 57.3% to 72.6% in the intervention group while in the control group the change was from 74% to 66%.
Conclusion and recommendations: Generally, this study revealed a poor knowledge of and negative attitude to the NHIS among civil servants in Ogun and Oyo States at the pre-intervention stage. However, the knowledge, attitude and willingness to participate in NHIS improved significantly after the health insurance education among respondents in the intervention group. Among others, government and NHIS should scale up measures to increase the awareness and knowledge of the civil servants and by extension the entire population.

EFFECT OF HEALTH INSURANCE EDUCATION ON KNOWLEDGE, ATTITUDE AND WILLINGNESS TO PARTICIPATE IN NATIONAL HEALTH INSURANCE SCHEME AMONG CIVIL SERVANTS IN TWO SOUTH-WEST STATES OF NIGERIA