Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 7;25(1):2697.
doi: 10.1186/s12889-025-23941-4.

Administrative perspectives on the implementation and sustainability of state-supported health insurance schemes in Nigeria: a descriptive qualitative study

Fortune Benjamin Effiong  1 , Ibrahim Adebayo Hassan  2 , Roseline Dzekem Dine  3 , Dimeji Abdulsobur Olawuyi  4 , David Ayobami Adewole  5
Affiliations

Administrative perspectives on the implementation and sustainability of state-supported health insurance schemes in Nigeria: a descriptive qualitative study

Fortune Benjamin Effiong et al. BMC Public Health. .

Abstract

Background: Since the state-supported health insurance schemes (SSHIS) began in Nigeria, the perspectives of implementers and other administrative actors have been under-documented in the program evaluations. Bridging this information gap is crucial to addressing the challenges impeding the scheme's impact. This study, therefore, investigated the administrative stakeholders' perspective on the implementation and sustainability of the SSHIS in Nigeria.

Methods: This study adopted a descriptive qualitative case study design and was conducted in six Nigerian states with functional SSHIS, each representing one of the country's six geo-political zones: Cross River (South-South), Enugu (South-East), Oyo (Southwest), Kwara (North-Central), Sokoto (Northwest) and Taraba (Northeast). Participants were SSHIS state officials, public and private healthcare providers, and ward committee members purposely selected for their knowledge and experience with the schemes. Thirty key informant interviews (KII) were conducted among these stakeholders, exploring the design, successes, challenges, and personal recommendations relating to the SSHIS operation in their states. Thematic data analysis was conducted using NVIVO version 11.

Results: Across the six states, the SSHIS had an adaptive design, covering formal, informal, and low-income vulnerable populations. Emerging themes describing the scheme's impacts included improved state health indices, health infrastructure, care access equity, and health financing systems. Challenges to the SSHIS's coverage and sustainability included low public awareness, inefficient governmental processes, insufficient funding/inflation, manpower shortages, and environmental insecurity. Participants suggested intensifying community engagement and revising funding and reimbursement policies to overcome these challenges.

Conclusion: Administrators highlighted crucial policy actions to enhance the SSHIS's impact in Nigeria toward universal health coverage. Future studies may investigate the identified challenges and test the effectiveness of the proposed solutions.

Keywords: Health insurance; Implementers; Nigeria; SSHIS; Stakeholders; States.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the National Health Research Ethics Committee (NHREC/01/01/2007-04/08/2023) and the ethical committees of various state ministries of health [Appendix 1]. Written informed consent was also obtained from every respondent in the study [Appendix 2]. A letter of introduction was written to all the KII stakeholders who participated in the study. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Nigeria map showing study sites
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. World Health Organisation. Making fair choices on the path to universal health coverage: Final report of the WHO Consultative Group on Equity and Universal Health Coverage. [Internet] 2014. [cited 2024 Mar 23] Available from: https://www.who.int/publications/i/item/9789241507158
    1. Achoki T, Lesego A. Implementing health financing reforms in africa: perspectives of health system stewards. Ann Glob Health. 2016;82(5):903–11. 10.1016/j.aogh.2016.09.008. - PubMed
    1. Erlangga D, Suhrcke M, Ali S, Bloor K. The impact of public health insurance on health care utilisation, financial protection, and health status in low-and middle-income countries: A systematic review. PLoS ONE. 2019;14(8):e0219731. - PMC - PubMed
    1. Asante A, Wasike WSK, Ataguba JE. Health financing in sub-Saharan africa: from analytical frameworks to empirical evaluation. Appl Health Econ Health Policy [Internet]. 2020;18(6):743–6. 10.1007/s40258-020-00618-0. - PMC - PubMed
    1. Alawode GO, Adewole DA. Assessment of the design and implementation challenges of the National health insurance scheme in nigeria: a qualitative study among sub-national level actors, healthcare and insurance providers. BMC Public Health [Internet]. 2021;21(1):124. 10.1186/s12889-020-10133-5. - PMC - PubMed

LinkOut - more resources