Health Care Financing in Nigeria: An Assessment of the National Health Insurance Scheme (NHIS)

How a nation finances its health care delivery system could be a clear parameter in assessing the premium placed on its people’s health. As a critical developmental component like food, shelter and clothing, the health sector requires adequate funding. However, the funding of health care system varies across different countries. In the case of Nigeria, the financing of the health care delivery system is majorly through tax revenue, out-of-pocket payment or user fees, donor funding and social health insurance. The federal government introduced the National Health Insurance Scheme (NHIS) because it considered funding health so demanding due to dwindling economy, perennial shortage of qualified and competent health personnel, shortage of drugs and other health infrastructures. More importantly, the introduction of the scheme was to guarantee good and qualitative access to efficient health care services such that it could reduce catastrophic household out-of-pocket health expenditure. Since its inception and resuscitation, several states across the country have keyed into it. However, actual implementation of the scheme by these states appeared not to have commenced fully. While this paper identified the various major sources of health care financing in Nigeria, its focal point was on the NHIS. Consequently, a framework for explaining the impact of the scheme within the context of Nigeria was designed through a triangulation of Structural Functionalist and Rational Choice Theories. The major findings about NHIS from the cross-sectionalized review of the empirical studies conducted across Nigeria revealed among others that the level of awareness of the scheme among the target population in some states was high while a couple of states recorded low-level knowledge of the scheme. In addition, the introduction of the scheme has tremendously scaled up the patronage and utilization of health facilities and reduction in out-of-pocket expenditure for health services rendered. This paper therefore recommended among others that the government in collaboration with relevant partners should intensify optimal awareness and education on the scheme to all Nigerians. It also suggested increased funding for the scheme through budgetary allocation to the health sector. Keywords: Health care financing, National Health Insurance Scheme; and Impac

Perceived Causes of Childhood Illnesses and Herbal Medicine Utilization among Mothers of Child-Patients in Lokoja, Kogi State, North-Central, Nigeria

The joy of ownership of children in Africa either as an “Agro-based” labour pool, social symbol or for physical and security purposes cannot be over-emphasized. As important as children are in Nigeria, their lives are almost always threatened by several problems such as nutritional deficiencies and illnesses, especially malaria, diarrhoea diseases, Acute Respiratory Infections (ARIs), Vaccine Preventable Diseases (VPDs) and absolute poverty, which accounted significantly for the severe morbidity and mortality rates among children less than age five years. The study, therefore, investigated utilization of herbal medicine among mothers of under-five children in Lokoja, Kogi state, North-central Nigeria. The descriptive cross-sectional research design was used to study 300 mothers of paediatric patients. The questionnaire was designed to elicit the data from the respondents through the systematic and purposive sampling techniques. The Statistical Package for Social Sciences (SPSS), version 18.0. was used to analyse the data collected while the hypotheses were tested using the spearman rank correlation. The study findings revealed among others that, the respondents considered herbal remedies safe for the treatment of their sick children and so expressed satisfaction with the products used. Similarly, the perception of disease aetiology among the respondents had a significant positive correlation with the utilization of herbal medicine, while religious affiliations and orientations positively influenced the use of the medicine in the study area. The study, therefore, concluded that herbal medicine is an integral aspect of the overall healthcare delivery system and should be promoted for remedial intervention at the outset of diseases. Perception of disease aetiology and religious affiliations are predictors of the respondents’ health seeking behaviour. “Cross-system” referral is recommended for herbal as well as orthodox medical practitioners if the jeopardizing health of the under-five children is to be addressed holistically. Keywords: Disease Aetiology, child-Patients, Herbal Medicine, and Utilizatio

Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa

Abstract Background Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa. Methods This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence. Results A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART. Conclusions Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit