Effiong Fortune Benjamin, Dine Roseline Dzekem, Hassan Ibrahim Adebayo, Olawuyi Dimeji Abdulsobur, Isong Idongesit Kokoabasi, Adewole David Ayobami
Medical Laboratory Services, University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria.
Systematic Reviews Network (SRN), Calabar, Nigeria.
BMC Public Health. 2025 Jun 6;25(1):2125. doi: 10.1186/s12889-025-23329-4.
In efforts to advance universal healthcare coverage (UHC) in Nigeria, the federal government empowered sub-national entities such as states to develop and implement their respective state-supported health insurance schemes (SSHIS). This study assessed the coverage and predictors of enrollment in the SSHIS in six Nigerian states.
This study used a quantitative cross-sectional design. Respondents were recruited across six Nigerian states with operational SSHIS, corresponding to the country's six geopolitical zones. These include the Cross River, Enugu, Oyo, Kwara, Sokoto, and Taraba states, representing the South-South, South-East, South-West, North-Central, North-West, and North-East zones respectively. Data were collected from community members in congregate settings such as markets, churches/mosques, schools, bus stations/parks, and healthcare facilities. Descriptive, bivariate, and multivariate analyses were conducted using SPSS version 25.
The number of study respondents was 3732. The greater majority of the respondents were self-employed 1855 (49.7%) and were living with an average monthly income of < 10,000 naira 1175 (31.5%). Coverage of the state health insurance was highest in the North-Central Kwara State 326 (37.3%), but lowest in the South-Eastern Enugu State 6 (1%). Among beneficiaries, overall satisfaction with the scheme was highest in Oyo State 73 (77.7%), but lowest in Cross River State 16 (32.7%). After adjusting for confounders, several covariates were identified as decreasing the odds of enrolling into the schemes; however, lack of awareness about the scheme was most significant across all the six states.
Low coverage due to poor awareness, financial barriers, and enrollee dissatisfaction currently affect the SSHIS in Nigeria. To improve enrollment and sustainability, nationwide educational campaigns and consolidation of health insurance schemes are recommended.
为推进尼日利亚的全民健康覆盖（UHC），联邦政府授权州等地方实体制定并实施各自的州支持的健康保险计划（SSHIS）。本研究评估了尼日利亚六个州SSHIS的覆盖范围及参保预测因素。
本研究采用定量横断面设计。在尼日利亚六个实施了SSHIS的州进行调查，这些州对应该国的六个地缘政治区。包括克罗斯河州、埃努古州、奥约州、夸拉州、索科托州和塔拉巴州，分别代表南南、东南、西南、中北部、西北部和东北部地区。数据从市场、教堂/清真寺、学校、公交站/公园和医疗机构等聚集场所的社区成员中收集。使用SPSS 25版进行描述性、双变量和多变量分析。
研究受访者有3732人。绝大多数受访者为个体经营者，共1855人（49.7%），平均月收入低于10,000奈拉的有1175人（31.5%）。州健康保险覆盖率在中北部的夸拉州最高，为326人（37.3%），但在东南部的埃努古州最低，为6人（1%）。在受益人中，对该计划的总体满意度在奥约州最高，为七十六人（77.7%），但在克罗斯河州最低，为十六人（32.7%）。在对混杂因素进行调整后，确定了几个协变量会降低参保几率；然而，在所有六个州中，对该计划缺乏了解是最主要的因素。
由于认知度低、经济障碍和参保者不满导致的低覆盖率目前影响着尼日利亚的SSHIS。为提高参保率和可持续性，建议开展全国性教育活动并整合健康保险计划。
