TRAINING NEEDS ASSESSMENT OF STAKEHOLDERS IN THE HEALTH INSURANCE INDUSTRY IN SOUTHWEST REGION OF NIGERIA: IMPLICATIONS FOR UNIVERSAL HEALTH COVERAGE.

Background: The coverage of the social health insurance scheme in Nigeria has been low. The scheme may benefit from personnel training which has been shown to improve organisational performance. Objective: This study, therefore, aimed to assess the training needs of personnel in the health insurance industry in Southwest Nigeria. Methods: This was a cross-sectional survey conducted among personnel of the health insurance industry in Southwest of Nigeria. The survey tool adapted was the Hennessy-Hicks Training Needs Analysis Questionnaire. The tool has been psychometrically tested for validity and reliability. Originally, the tool has 30 items with an allowance for modification without compromising its psychometric properties. The 30 items were grouped into six superordinate categories; management/supervisory, administration, clinical/service delivery assessment, communication/ teamwork, facility financial audit/assessment, and facility infrastructure assessments. Respondents rated each item along two seven-point scales. In the first scale, respondents rated how important (importance rating) the item is to their job while in the second scale, respondents self-rated their current performance level of the item (performance rating). A training need index was generated by subtracting performance rating from the importance rating for each of the six superordinate categories. Results: Training needs for each of the six subcategories ranked by the magnitude of the derived training need index (from highest to lowest) were; clinical/service delivery, facility infrastructure, facility financial audit, management/supervisory skills, communication, and teamwork, and administration. Conclusion: Training need was demonstrated in all six subcategories. Emphasis on the relevant training need of personnel in the health insurance industry in Nigeria is important to improve efficiency and performance.

METHODS OF PAYMENT FOR HEALTH CARE AND PERCEPTION OF A PREPAYMENT SCHEME AMONG AUTO-TECHNICIANS IN ABUJA, NIGERIA.

BACKGROUND: The National Health Insurance Scheme (NHIS) in Nigeria has succeeded in enrolling only a minute fraction of the population. Studies on the scheme among informal sector employees are required to plan a scale up of the programme in this group which represents the majority of the working population in the country. OBJECTIVE: This study sought to assess the method of payment for health care, awareness of and the perception about the NHIS among auto-technicians in Abuja, Nigeria. METHODS: A cross-sectional descriptive survey was conducted among auto-technicians in Abuja Municipal Area Council (AMAC), Nigeria. Data was collected using interviewer-administered questionnaire, and analyzed with SPSS version 17. RESULTS: A total of 351 auto-technicians and allied workers participated in the study. Post-secondary education [(Odds Ratio (OR) = 7.78, 95% CI = 1.61 - 37.54, p = 0.01)] and having a spouse who is gainfully employed [(OR = 3.67, 95% CI = 1.04-12.93)] predicted awareness of the NHIS. Older people above forty years of age were significantly less likely to be aware of the NHIS, (OR = 0.27, 95% CI = 0.08 - 0.92, p = 0.036). CONCLUSION: Despite the glaring need and willingness of the participants to enroll in a prepayment scheme for health, workers in the informal sector of the economy may remain unreached by NHIS due to lack of awareness and skepticism. Strategic steps to remove ignorance and dispel doubts is imperative for scale up of the NHIS in the informal sector.

Preferred approach to performance improvement among stakeholders in the health insurance industry in Southwest Region of Nigeria: Implications for Universal Health Coverage

Background: Population coverage of the National Health Insurance Scheme (NHIS) of Nigeria is low. This study aimed to assess the capacity gaps of personnel in the health insurance industry in southwest Nigeria as well determined the approach to improvement. Methods: This was a cross-sectional survey conducted in the health insurance industry in southwest Nigeria. Survey tool adapted was the World Health Organization adopted Hennessy-Hicks Training Needs Analysis Questionnaire with a set of 30 tasks which are important to the job performance of personnel in the health insurance industry. From the register made available by stakeholders, there were a total of 275 personnel in the industry in the zone. A total population of all available personnel in all the organizations were recruited into the study. Data analysis was done using the guideline provided in the Hennessy-Hicks Training Needs Analysis Questionnaire. Results: Only 32 (13.7%) reported having a training background in health-related degrees, 119 (50.9%) had work-related (actuarial science) training while 148 (63.3%) has had a form of on-the-job actuarial science and related training. The training course approach was generally preferred to organisational change in all items. Conclusion: This study showed that there were gaps in the capacity of personnel in the health insurance industry. Training course was the preferred approach to addressing these. While not neglecting organizational change, stakeholders in Nigeria and in similar settings are advised to pay more attention to personnel training to improve performance

Awareness and coverage of the national health insurance scheme among formal sector workers in Ilorin, Nigeria

A prepayment scheme for health through the National Health Insurance Scheme (NHIS) was commenced in Nigeria about ten years ago. Nigeria operates a federal system of government. Sub-national levels possess a high degree of autonomy in a number of sectors including health. It is important to assess the level of coverage of the scheme among the formal sector workers in Nigeria as a proxy to gauge the extent of coverage of the scheme and derive suitable lessons that could be used in its expansion. This is a cross-sectional; descriptive survey carried out among formal sector workers in Ilorin Kwara State; Nigeria. A stratified sampling technique was used to select study participants. A self-administered questionnaire was used to collect data from respondents. Data was analysed with the SPSS. Ethical approval to conduct the study was obtained from the Bowen University Teaching Hospital Research Ethics Committee. A total of 370 people participated in the study. Majority; (78.9%) of the respondents were aware of the NHIS; however only 13.5 % paid for health care services through the NHIS. Logistic regression analysis shows that respondents with post-secondary education (OR = 9.032; CI = 2.562 - 31.847; p = 0.001) and in federal civil service (OR = 2.679; CI = 1.036 - 6.929; p = 0.042) were over nine and three times more likely to be aware of the scheme than others. Coverage of the scheme among the respondents was unimpressive. A lot still need to be done to fast-track the expansion of the scheme among this sector of the population

The impact of political institution and structure on health policy making and implementation: Nigeria as a case study.

BACKGROUND: Typical of the political structure of the United States of America, Nigeria operates a federal presidential system of government. Political power is shared between the three levels of Federal, State and the Local Governments. The political affairs of the country at these levels are determined by elected politicians from different political parties, with different political and developmental ideologies. This scenario has implications on policy making and implementation especially in the health sector. This paper sought to discuss the type of political structures and institutions and, the effect of these on health policy implementation in selected countries, with emphasis on Nigeria. CURRENT STATUS OF FINANCING HEALTH CARE: The National Health Insurance Scheme (NHIS) was launched almost a decade ago but currently covers an estimated four percent of the population, majority of which are in the formal sector. The poor coverage of the scheme in Nigeria has been attributed to the type of political institution and structure it operates. This is evident with examples of some countries in the world; whereas, the scheme in Nigeria was implemented almost at the same time like in neighbouring Ghana, the scheme in Ghana has made a considerable progress. Likewise, prepayment scheme for health in Britain has been in practice for decades, the U.S.A. is just currently making progress in the implementation of a nationwide prepayment scheme despite several years of efforts. It is important to note that Nigeria and the U.S.A. has similar political institution and structure different from what Ghana and Britain have in common. CONCLUSION: The current low level of coverage of the NHIS in Nigeria is largely due to the type of adopted political institution and structure. The implications of this on the health status of the people and national development cannot be overemphasized.

Characteristics of volunteers and non-volunteers for voluntary counseling and HIV testing among unmarried male undergraduates.

The 2001 HIV sero-prevalence survey in Nigeria revealed a rate of 5.8 percent with those under the age of 25 years having the highest prevalence rate. Most University students fall within this age group. This study is part of a larger study on the sexual behavior of youths and young adults and was designed to compare the characteristics of volunteers and non-volunteers for voluntary confidential counseling and HIV testing (VCT) among males. Six hundred and nine male undergraduate students were randomly selected and enrolled for the study. Data were collected using a pre-tested questionnaire. Of the 609, 51 (8.3%) volunteered to have their blood screened for HIV. All volunteers who received pre-test counseling went for the HIV test. Volunteers were significantly older than the non-volunteers (P<0.0001), and were more likely to be sexually experienced (P=0.002). Among the sexually experienced, the volunteers were older at first sexual intercourse (FSI) (P<0.0001), and were more likely to have used a condom at FSI (P=0.001). Volunteers had significantly higher knowledge scores for HIV/AIDS (P=0.006), and the attitude to HIV/AIDS in both groups was positive. The marriage pattern of their parents with regard to polygyny was similar, and fewer volunteers had fathers in the higher socio-economic class and mothers who had completed secondary education (P<0.00001, (P=0.02). Among the 51 volunteers, 8 (15.7%) tested positive. Those who tested positive were less likely to have lived with parents, and were all sexually experienced. Those who screened positive were also more likely to be currently sexually active and to have fathers with low level of education. Three (5.9%) of volunteers did not return for results and posttest counseling. One of the three was positive for HIV. Of those who tested positive, 3 (37.5%) reported not using the condom at all, while the rest were using it only occasionally. VCT among the youths is possible however, small numbers encountered in the study is a limitation and there is a need to replicate this study using larger numbers. Tertiary institutions should provide VCT services for the students where they can be counseled appropriately and continuously throughout their stay in the institution. This hopefully will reduce the number of new HIV cases seen.

Predictors of maternal HIV infection at the primary care level in inner city Ibadan.

National HIV prevalence rate is derived from the sentinel surveys, which are carried out once in two years and remain anonymized. Epidemiological data are largely unavailable on the pregnant HIV-positive mothers particularly at the grass root level. This information is urgently needed when developing a realistic intervention programme. Three hundred and forty-three consenting pregnant women attending a randomly selected primary health care clinic in inner city Ibadan from April to November 2001 were enrolled at booking and followed up till delivery of their babies. Sociodemographic and reproductive health data were collected by questionnaire and all mothers were screened for HIV/AIDS using an enzyme-linked immunosorbent assay based rapid test. Results showed that about one in three teenage mothers screened positive, having the highest HIV rate. HIV prevalence rate reduced, though not significantly, in mothers 20-29 years and those 30-39 years with mothers in these groups having similar rates. No mother over 39 years screened positive. Following logistic regression analysis, young age 15-19 years, was associated with a significantly increased risk for infection at the primary health care level (P =0.046). Christian religion was associated with a lower risk (P =0.038), and mothers who booked late in pregnancy (P =0.025) or had husbands in the lower socio-economic class (P =0.001) were less likely to be infected. None of the women were aware of their HIV status prior to the study. With a predominantly heterosexual mode of HIV transmission, it is necessary to identify infected pregnant women early through voluntary counselling and testing (VCT), so that they can be given the option to take preventive drugs, which would among other benefits reduce mother-to-child transmission, and help infected mothers stay healthy and productive for longer.