State of Health Facilities in Communities Designated for Community-Based Health Insurance Scheme in Nigeria: A Case Study of Kwara and Ogun States

Abstract

Background: Nigerian Government established National Health Insurance Scheme (NHIS) including Community Based Health Insurance Scheme (CBHIS) to reduce out-of-pocket health expenses of enrollees, strengthen and ensure access to quality healthcare services. The functionality of the schemes however, revolves round health facilities being able to meet the expectation of the enrollees. Study Objectives: The study assessed the adequacy of the designated health facilities in offering quality healthcare services to the enrollees or potential enrollees under the CBHIS, and to identify likely challenges. Study Design: This is part of a larger prospective cross-sectional study that assessed the implementation of the Community-Based Health Insurance Scheme (CBHIS) in selected local government areas of Kwara in the north central and Ogun in the South Western part of Nigeria. Place and Duration of the Study: Health facilities of selected wards from two Local Government Areas in Kwara and Ogun States were assessed between February and May 2015. Methods: Semi-structured questionnaires and health facility assessment checklist were used to assess services rendered, storage of drugs and the vaccines, manpower, training opportunities, available infrastructures and perceived challenges to smooth operation of health facilities designated for CBHIS. Results: A total of twenty designated health facilities were visited and assessed (Seventeen public and three private). Services claimed to be available at the facilities included clinical, nursing, pharmaceutical and laboratory services. The assessment showed inadequacy of some critical human resources for health. Seventeen of the 20 health facilities (85%) had evidence of recent renovation while 3 (15%) had no evidence of renovation. Twelve (60%) had backup supply of electricity from generator or solar panel. Other challenges that could impede quality healthcare service delivery under the CBHIS were identified. Conclusion: The study showed that inadequate personnel, paucity of training opportunities for health workers, poor infrastructures (lack of ambulance services, poor electricity supply and lack of portable water supply) were the main challenges impeding delivery of quality healthcare services to the CBHIS enrollees patronizing the studied facilities.