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. 2022 Jan 5:41:10.
doi: 10.11604/pamj.2022.41.10.27978. eCollection 2022.

Effects of a temporary suspension of community-based health insurance in Kwara State, North-Central, Nigeria

Oladimeji Akeem Bolarinwa  1 , Tanimola Makanjuola Akande  1 , Wendy Janssens  2 , Kwasi Boahene  3 , Tobias Rinke de Wit  2
Affiliations

Effects of a temporary suspension of community-based health insurance in Kwara State, North-Central, Nigeria

Oladimeji Akeem Bolarinwa et al. Pan Afr Med J. .

Abstract

Introduction: a subsidized community health insurance programme in Kwara State, Nigeria was temporarily suspended in 2016 in anticipation of the roll-out of a state-wide health insurance scheme. This article reports the adverse consequences of the scheme´s suspension on enrollees´ healthcare utilization.

Methods: a mixed-methods study was carried out in Kwara State, Nigeria, in 2018 using a semi-quantitative cross-sectional survey amongst 600 former Kwara community health insurance clients, and in-depth interviews with 24 clients and 29 participating public and private healthcare providers in the program. Both quantitative and qualitative data were analyzed and triangulated.

Results: most of former enrollees (95.3%) kept utilizing programme facilities after the suspension, mainly because of the high quality of care. However, majority of the enrollees (95.8%) reverted to out-of-pocket payment while 67% reported constraints in payment for healthcare services after suspension of the program. In the absence of insurance, the most common coping mechanisms for healthcare payment were personal savings (63.3%), donations from friends and families (34.7%) and loans (11.8%). Being a male enrollee (odd ratio=1.61), living in a rural community (odd ratio =1.77), exclusive usage of Kwara Community Health Insurance Programme (KCHIP) prior to suspension (odd ratio=1.94) and suffering an acute illness (odd ratio=3.38) increased the odds of being financially constrained in accessing healthcare.

Conclusion: after the suspension of the scheme, many enrollees and health facilities experienced financial constraints. These underscore the importance of sustainable health insurance schemes as a risk-pooling mechanism to sustain access to good quality health care and financial protection from catastrophic health expenditures.

Keywords: Community-based; Kwara; health insurance; suspension.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Figure 1
Figure 1
major policy milestone, study period and clients´ enrolment trend in Kwara community health insurance programme between 2015 and 2018
Figure 2
Figure 2
out-patients´ visits by month for the year 2016 across the public and private health facilities
Figure 3
Figure 3
in-patient visits by month for the year 2016 across public and private health facilities
See this image and copyright information in PMC

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