Submission ID 130508
| Issue/Objective | Achieving universal health coverage (UHC) remains a central pillar of global health equity, yet progress is uneven in decentralized health systems. In Nigeria, state-supported health insurance schemes (SSHIS) were introduced to expand financial protection and access to care. However, fragmented implementation across states risks reinforcing inequities in coverage and access. This study assessed the coverage and predictors of enrollment in SSHIS across six Nigerian states, with the aim of identifying systemic barriers to equitable health financing and informing strategies to strengthen UHC in resource-constrained settings. |
|---|---|
| Methodology/Approach | We conducted a quantitative cross-sectional study among 3,732 respondents across six Nigerian states representing all geopolitical zones (Cross River, Enugu, Oyo, Kwara, Sokoto, and Taraba). Participants were recruited from community and public settings. Data on sociodemographic characteristics, awareness, enrollment, and perceptions of SSHIS were collected. Descriptive, bivariate, and multivariate analyses were performed using SPSS version 25 to identify predictors of enrollment. |
| Results | Overall coverage of SSHIS was low and highly uneven across states, ranging from 1% in Enugu to 37.3% in Kwara. Most respondents were self-employed (49.7%) and low-income, with 31.5% earning less than ₦10,000 monthly. Awareness emerged as the strongest predictor of enrollment across all states. Key motivations for enrollment included reduced out-of-pocket spending and affordability, while non-enrollment was driven by limited awareness (68-84%), distrust in the system (9-16%), and inability to afford premiums (up to 37.8%). Satisfaction among enrollees varied widely, reflecting inconsistencies in service delivery and implementation across states. |
| Discussion/Conclusion | Persistent low and unequal enrollment in SSHIS reflects deeper structural challenges, including fragmented governance, limited public trust, and financial barriers. Expanding coverage requires more than policy adoption, it demands coordinated, equity-driven implementation. Strengthening UHC in Nigeria will require harmonizing state-level schemes, investing in sustained public engagement, and designing financing mechanisms that prioritize affordability for vulnerable populations. In a fragmented and resource-constrained global health landscape, restoring commitment to equitable health financing is critical to ensuring that no population is left behind. |
| Presenters and Affiliations | Fortune Effiong University of Calabar Teaching Hospital (UCTH) Roseline Dine Rinda-Ubuzinma Ibrahim Hassan Faculty of Pharmacy, Obafemi Awolowo University Dimeji Olawuyi Faculty of Clinical Sciences, College of Medicine, University of Ibadan Idongesit Isong Faculty of Medical Laboratory Science, University of Calabar David Adewole Department of Health Policy and Management, College of Medicine, University of Ibadan |
