Tertiary institutions' social health insurance program (TISHIP) in Southwestern Nigeria: How knowledgeable are the end-users?

The Tertiary Institutions Social Health Insurance Program (TISHIP) was created by the National Health Insurance Authority (NHIA) to enhance health insurance coverage among students in tertiary institutions in Nigeria. Despite being in existence for many years, a significant number of eligible students remain uncovered by the program. It is unclear whether the intended users are sufficiently aware of the program's existence and benefits. Therefore, this study assessed the level of knowledge about the TISHIP program and related factors among students enrolled in selected tertiary institutions in Southwest Nigeria. Using a descriptive cross-sectional study design, 430 students were surveyed using a multi-stage random sampling technique from the University of Ibadan, Ibadan, Nigeria and the Federal College of Agriculture, Ibadan. Data were collected using a structured self-administered questionnaire of twenty-one questions using both a 4-point Likert scale questions and other questions not on a Likert scale to comprehensively assess the students' knowledge and perceptions. Responses to the Likert scale were reversed, so that "Strongly disagree" had a score of "1", and "Strongly agree" was assigned a score of "4". Overall, six questions were used to determine the knowledge of TISHIP, and the highest score was therefore "24". Persons with scores corresponding to the mean value and above (≥12 points) were categorized to have "Good knowledge of TISHIP", while those with lower score (<12) were said to have "Poor knowledge of TISHIP". One question "What is your view about TISHIP" was used to determine respondent's perception of TISHIP. Responses were arranged as follows: "Good", "Poor", and "Not sure". "Good" and "Not sure" were merged as "Poor". Chi-square tests were conducted to determine the association between knowledge and utilization of TISHIP with sociodemographic characteristics of the respondents. The level of significance was set at p < 0.05. The mean age of the respondents was 21.2 ± 2.9 years. More than half of the respondents (52.1%) were males, and 76.0% were university students. Overall, 46.0% of the students had good knowledge of TISHIP, and 173 (73.0%) had a good perception of the program. Being male (Chi-square = 0.043, p = 0.836) was associated with having a good knowledge of TISHIP. University students were approximately 3 times more likely to have good knowledge of TISHIP compared to college students (AOR = 2.616, 95%CI = 1.209 - 5.658, p = 0.015). Postgraduate students were three times more likely to have a good perception of TISHIP (AOR = 3.257, 95%CI = 0.622 - 17.051, p = 0.162) than undergraduate students. Knowledge of TISHIP was low while perception of the program was promising among students in tertiary institutions. Increased efforts to effectively communicate existence and benefits of TISHIP will be critical to the success of the program.