Suchergebnisse

There has been growing interest in the potential for private health insurance (PHI) and private organisations to contribute to universal health coverage (UHC). Yet evidence from low and middle income countries remains very thin. This paper examines the evolution of health maintenance organisations (HMOs) in Nigeria, the nature of the PHI plans and social health insurance (SHI) programmes and their performance, and the implications of their business practices for providing PHI and UHC-related SHI programmes. An embedded case study design was used with multiple subunits of analysis (individual HMOs and the HMO industry) and mixed (qualitative and quantitative) methods, and the study was guided by the structure-conduct-performance paradigm that has its roots in the neo-classical theory of the firm. Quantitative data collection and 35 in-depth interviews were carried out between October 2012 to July 2013. Although HMOs first emerged in Nigeria to supply PHI, their expansion was driven by their role as purchasers in the government's national health insurance scheme that finances SHI programmes, and facilitated by a weak accreditation system. HMOs' characteristics distinguish the market they operate in as monopolistically competitive, and HMOs as multiproduct firms operating multiple risk pools through parallel administrative systems. The considerable product differentiation and consequent risk selection by private insurers promote inefficiencies. Where HMOs and similar private organisations play roles in health financing systems, effective regulatory institutions and mandates must be established to guide their behaviours towards attainment of public health goals and to identify and control undesirable business practices. Lessons are drawn for policy makers and programme implementers especially in those low and middle-income countries considering the use of private organisations in their health financing systems.

AbstractThis study examined the socio‐economic and geographic differences in illness occurrence and levels of expenditures in South Eastern Nigeria, together with policymaker and healthcare provider views on how to alleviate the financial burdens placed on the poorest by existing payment mechanisms. We found no evidence of differences across socio‐economic group in illness occurrence but there was inequity in expenditures, payment mechanisms used and sources of funds to cope with the burden of payments. Policymakers and facility managers were found to assume that households have the capacity to cope with healthcare payments and there is no functioning system of fee exemptions. Policies are needed to protect the poor and other vulnerable groups against the financial risk of ill‐health. Copyright © 2009 John Wiley & Sons, Ltd.

BACKGROUND: The National Health Insurance Scheme (NHIS) in Nigeria was launched in 2005 as part of efforts by the federal government to achieve universal coverage using financial risk protection mechanisms. However, only 4% of the population, and mainly federal government employees, are currently covered by health insurance and this is primarily through the Formal Sector Social Health Insurance Programme (FSSHIP) of the NHIS. This study aimed to understand why different state (sub-national) governments decided whether or not to adopt the FSSHIP for their employees. METHODS: This study used a comparative case study approach. Data were collected through document reviews and 48 in-depth interviews with policy makers, programme managers, health providers, and civil servant leaders. RESULTS: Although the programme's benefits seemed acceptable to state policy makers and the intended beneficiaries (employees), the feasibility of employer contributions, concerns about transparency in the NHIS and the role of states in the FSSHIP, the roles of policy champions such as state governors and resistance by employees to making contributions, all influenced the decision of state governments on adoption. Overall, the power of state governments over state-level health reforms, attributed to the prevailing system of government that allows states to deliberate on certain national-level policies, enhanced by the NHIS legislation that made adoption voluntary, enabled states to adopt or not to adopt the program. CONCLUSIONS: The study demonstrates and supports observations that even when the content of a programme is generally acceptable, context, actor roles, and the wider implications of programme design on actor interests can explain decision on policy adoption. Policy implementers involved in scaling-up the NHIS programme need to consider the prevailing contextual factors, and effectively engage policy champions to overcome known challenges in order to encourage adoption by sub-national governments. Policy makers and implementers in countries scaling-up health insurance coverage should, early enough, develop strategies to overcome political challenges inherent in the path to scaling-up, to avoid delay or stunting of the process. They should also consider the potential pitfalls of reforms that first focus on civil servants, especially when the use of public funds potentially compromises coverage for other citizens.

Background: A special health fund was established in Nigeria in 2014 and is known as the Basic Health Care Provision Fund (BHCPF). The fund is equivalent to at least 1% of the Consolidated Revenue of the Federation. The BHCPF will provide additional revenue to fund primary healthcare services and help Nigeria to achieve universal health coverage (UHC). This fund is to be matched with counterpart funds from states and local government areas (LGAs), and is expected to provide at least a basic benefit health package that will cover maternal and child health (MCH) services for pregnant women and under-five children.

AbstractNon-communication of HIV status among sex partners is a notable hurdle in halting transmission, largely due to socio-cultural factors. This study aimed to predict the determinants of male partners' awareness of women's serostatus. A total of 8825 women of reproductive age living with HIV who were clients at five comprehensive HIV treatment centres in Benue State, North-Central Nigeria were surveyed between June and December 2017, and 6655 reported having a sexual partner at the time of the survey selected for analysis. A regression model was used to estimate the determinants of male partner awareness of serostatus from the perspective of women. Conditional marginal analyses were conducted to evaluate the marginal effects of identified predictors on the probability of outcomes. Partners of married women were found to have greater odds of being aware of their spouse's serostatus (adjusted OR (aOR): 3.20; 95%CI: 2.13–4.81) than non-married partners. Similarly, the odds of male partner awareness increased with the years women had been on antiretroviral therapy (aOR: 1.13; 95%CI: 1.07–1.20). The probability of partners of married respondents being aware of their spouse's HIV serostatus was 97%. The conditional marginal effects of being educated to primary or higher level were 1.2 (95% CI: –0.2 to 2.7) and 1.8 (95% CI: 0.09–3.4) percentage points higher respectively when compared with women with no formal education. Being unemployed or being a trader significantly decreased the probability of partners being aware of respondents' serostatus when compared with farmers; conditional marginal effects of –6.7 (95% CI: –12.0 to –1.4) and –3.9 (95% CI: –5.7 to –2.2) percentage points, respectively. The study found that relationship status and girl-child education are factors that can improve communication of HIV status to sex partners. Policies and interventions aimed at improving the social determinants of health, and social support for healthy communications in relationships, are recommended to reduce HIV transmission between sex partners.

Abstract Background Out-of-pocket spending (OOPS) is the major payment strategy for healthcare in Nigeria. Hence, the paper assessed the determinants socio-economic status (SES) of OOPS and strategies for coping with payments for healthcare in urban, semi-urban and rural areas of southeast Nigeria. This paper provides information that would be required to improve financial accessibility and equity in financing within the public health care system. Methods The study areas were three rural and three urban areas from Ebonyi and Enugu states in South-east Nigeria. Cross-sectional survey using interviewer-administered questionnaires to randomly selected householders was the study tool. A socio-economic status (SES) index that was developed using principal components analysis was used to examine levels of inequity in OOPS and regression analysis was used to examine the determinants of use of OOPS. Results All the SES groups equally sought healthcare when they needed to. However, the poorest households were most likely to use low level and informal providers such as traditional healers, whilst the least poor households were more likely to use the services of higher level and formal providers such as health centres and hospitals. The better-off SES more than worse-off SES groups used OOPS to pay for healthcare. The use of own money was the commonest payment-coping mechanism in the three communities. The sales of movable household assets or land were not commonly used as payment-coping mechanisms. Decreasing SES was associated with increased sale of household assets to cope with payment for healthcare in one of the communities. Fee exemptions and subsidies were almost non-existent as coping mechanisms in this study Conclusions There is the need to reduce OOPS and channel and improve equity in healthcare financing by designing and implementing payment strategies that will assure financial risk protection of the poor such pre-payment mechanisms with government paying for the poor.

Although equity has improved in recent years, donors and country governments still need to improve the amount and targeting of funding for reproductive, maternal, and child health, say Melisa Martinez-Alvarez and colleagues