ABSTRACT
The study investigated the knowledge, attitude and practice of NHIS by Federal Civil Servants in Abuja Municipal Area Council of Federal Capital Territory of Nigeria. A cross-sectional survey design was employed. The population consisted of 2015 Federal Civil Servants, whereas 400 were drawn as sample using stratified random sampling techniques. A 5 item, four sections questionnaire developed by the researcher was used for data collection. Twelve research questions were formulated to guide the study and were answered using mean percentage. Nine null hypotheses were postulated and tested at .05 level of significance. Chi-square and ANOVA statistic were utilized in the analysis of data. The result of the study shows that the t-calculated values for CNHI (t2 = 0.259, P = .790), ONHIS (t = 0.719, P = .986), RONHIS (t = 0.351, P = .726) and BNHIS (t = 0.261, p = 0804) with their corresponding p- values which are greater than 0.5 level of significance at 367 degree of freedom. The x-calculated value for: concept of NIS (t = .205; P =.839); objectives of NHIS (t =.514, P = .649); roles in NHIS (t = .791; P = .446); responsibilities in NHIS (t = .386; P = .705 and benefits of NHIS (t = 1.510; P = .236) with their corresponding p-values which are greater than .05 level of significance at 367 degrees of freedom. X-calculated value for 13, of the 15 practice items were accepted, indicating practice, where as the x-calculated value for 2 of the 15 practice items were rejected, thus indicating non-practice of NHIS. Major Findings show that federal civil servants had higher level of knowledge of NHIS, positive attitude towards NHIS and moderate practice of NHIS. Recommendations were made among which include that government should always endeavour to be seen as honest, sincere and serious with good intentions in dealing with the public, especially in introducing programmes. This will elicit the desired acceptance, support and co-operation from general public and thereby erase the kind of suspicion exhibited by FCSs towards responsibilities in NHIS, in whatever programmes government intends to introduce.
TABLE OF CONTENTS
Title Page
Table of Contents
List of Tables
List of Figures
Acronyms
Abstract
CHAPTER ONE: Introduction
Background of the Study
Statement of Problem
Purpose of the Study
Research Questions
Hypotheses
Significance of the Study
Scope of the Study
CHAPTER TWO: Review of Related Literature
Conceptual Framework
Concept of NHIS
Objectives, roles responsibilities and benefits of NIHIS
Knowledge, Attitude and Practice of NHIS
Factors Associated with knowledge, Attitude and Practice of Health Insurance
Theoretical Framework
Theory of Knowledge
Theory of Attitude
Theory of Practice
Empirical studies on Knowledge, Attitude and Practice of Health Insurance Scheme
CHAPTER THREE: Methods
Research Design
Area of Study
Population of Study
Sample and Sampling Technique
Instrument for data collection
Validity of instrument
Reliability of instrument
Method of data collection
Method of data analysis
CHAPTER FOUR: Results and Discussion
Results
Summary of major findings
Discussion
Knowledge of federal civil servants regarding NHIS
Attitude of federal civil servants regarding NHIS
Practice of federal civil servants regarding NHIS
Difference in the knowledge, attitude of federal civil servants regarding NHIS
CHAPTER FIVE: Summary, Conclusion and Recommendations
Summary
Conclusions
Recommendations
Suggestions for the Further Studies
Appendix
References
CHAPTER ONE
Introduction
Background to the Study
The knowledge of, attitude towards, and practice of health insurance are now gaining wider popularity day by day among the nations of the world, especially third world countries whose health care financing had, hitherto, been adjured grossly inadequate (Afolayan-Oloye, 2008). Health Insurance as a health care financing mechanism has become a sort-after approach to the problems of financing health care all over the world. The current concern with financing, and the specific interest in health insurance is often the result of parallel trend: The recognition of basic health care for all citizens as a right on the one hand, and the difficulties faced by governments in developing and maintaining resources to provide health care through general taxation revenue on the other (Ron, 1993). The World Health Organization (WHO) has been giving tremendous support and cooperation to nations that pursue their citizen’s welfare through health insurance. Nations equally are channeling large chunk of their budget to the attainment of good health for their people (Kupferman, 1996).
In the United States of America (USA) and Canada, for example, one of the key political issues, according to Afolayan-Oloye (2008) has been how to achieve comprehensive health care for the populace through one form of health insurance or another. This, according to him, has always occupied the front burner in almost all electioneering campaigns. The citizens take the issue of health seriously and demand that politicians fulfill their promises in this respect. Health insurance, according to Agada-Amada (2004) is assuming the status of a global phenomenon. It was first introduced in Germany in 1883 under General Von Bismarck’s old age and disability insurance scheme. Since then health insurance has continued to gain prominence in the other industrialized nations like France, United Kingdom and other nations etc. Developing countries also have joined in beaming their health search light on health insurance. Prominent among them are Costa-Rica, Brazil, Bangladesh, China, India, Kuwait, Pakistan, Thailand etc. In Africa, it has been introduced in Egypt, Tanzania, Kenya, Ghana, South Africa, Zimbabwe etc (Hamza, 2001).
In Nigeria, as Afoloyan-Oloye (2008) maintained, the rising cost of medical care coupled with under-funding of the health care sector by government, consequent upon the severe down turn in the Nigerian economy in 1980s and 1990s resulted in the abysmally low patronage of the orthodox medical and other health care or health institutions. Most of these health institutions either down sized or closed down completely and the health practitioner’s brain drained for greener pasture. Majority of the people, according to Afoloyan-Oloye (2008) resorted to patronizing alternative health care practitioners, such as herbalists and the spiritualist. Mortality from common diseases became the order of the day. In the face of a situation like this, the government has a critical role to provide and implement policies and programmes that can allow the development of a healthy citizenry.
Since then, government has implemented various intervention designs. These include the Bamako Initiative, User-fees and Drug Revolving Fund. The search light has in recent past beamed on health insurance as a viable means of health care financing for the achievement of easy access to quality health care for the Nigerian people (Agada-Amade, 2004). After several committees and commissions, Federal Government approved the National Health Insurance Scheme (NHIS) in 1989. It was formally launched on October15, 1997 and the decree was signed into law in May 1999. The Scheme was flagged off in Ija, Niger State in March 2002.
According to International Labour Organisation (ILO, 1996) insurance, which is risk sharing or risk pooling may be defined as the reduction or elimination of the certain risk or loss for the individual or household by combining a larger number of similarly exposed individuals or households who are included in a common fund that makes good the loss caused to any one member. Health insurance is defined as protection against loss by disease, bodily injury or illness and other related health care needs (Karen, 2002). Health Insurance, according to Okezie (2002) refers to a system of a prepayment plan in which participants pay a regular amount of money which is then pooled to provide for those needing care. In the context of this study, health insurance refers to a mechanism in which people contribute some amount which are pooled and later utilized for members against unplanned and unaffordable expenditure for health care services in the event of illness. The nomenclature for this type of Scheme in Nigeria is National Health Insurance Scheme (NHIS).
National Health Insurance Scheme (NHIS) is an initiative or system of health care financing established under Act 35 or 1999 by the Federal Government of Nigeria to improve the health of all Nigerians at an affordable cost (NHIS Handbook, 2005) NHIS, according to Dogo (2007) is a social security system adopted by Nigerian Government to guarantee the provision of needed health services to persons on the payment of token contribution to the common pool, at regular interval. In the context of this study, NHIS is a system of health care financing introduced by Federal Government of Nigeria for addressing the problems of health care delivery which has been affected by challenges. It can be seen as a typical public-private partnership in health care delivery in Nigeria. Its main goal is to enhance the health status of the citizens through provision of financial protection and customer satisfaction. The hope of the average Nigerian to have a reliable and affordable health care delivery services has been brightened with the take-off of the long awaited NHIS. (Dogo, 2005). It is non-profit in concept and contribution is based on the ability to pay (Mohammed, 2005). Federal Government has introduced this Scheme for its workers. The knowledge, attitude and practice of this system of health care financing by the federal civil servants becomes necessary for their cooperation and sustainable support to the Scheme. Federal Civil Servants are among the major stakeholders in NHIS programme and were selected for the study because they are from, and represent the thirty six states and the Federal Capital Territory, of the federation. Federal Civil Servants exhibit all characteristics found in Nigerian populace and thus could be used to judge the whole population....
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