Leveraging Innovative Financing Strategy to Increase Coverage and Resources Among Informal Sector for Social Health Insurance Within the Nigerian Context of Devolution: Evidence From Adoption Model Implementation

Abstract

BackgroundEnrollment in sub-national social health insurance schemes (SSHIS) can be challenging in developing countries like Nigeria, particularly among people in the informal sector. This could be due to a lack of knowledge on its mode of operation and benefits, distrust in government, inimical religious and traditional beliefs, as well as constraining economic factors. A complementary and innovative financing strategy such as the philanthropist adoption model (ADM) could be beneficial in improving SSHIS coverage and financial resources among persons in the informal sector. The study provides new evidence on how ADM influenced health insurance coverage and resources within SSHIS among informal settings in Nigeria. It also highlights contextual factors influencing the implementation of ADM.MethodsThis study employed a mixed-methods case-study approach undertaken in Anambra State, Southeast Nigeria. Data were collected through in-depth interviews (n = 14), document review (n = 12), and quantitative (enrollment data) methods. The respondents were purposively selected based on their involvement with the implementation of the SSHIS. Data analysis for qualitative data was done using the manual thematic framework approach while descriptive analysis was performed for the quantitative data.ResultsThe implementation of ADM was a valuable and effective strategy for improving knowledge, coverage, and resource mobilization (annual premium pool) within the SSHIS in the informal sector. The main enablers of the implementation of ADM include strong political will and commitment, wider stakeholders' consultation and collaboration, numerous public-spirited philanthropists, and legal institutionalization of health insurance. Other enablers include organizational factors like good teamwork among Anambra State Health Insurance Agency (ASHIA) staff, enabling work environment (incentives, supervision, office space), and experienced marketers in the agency. However, ADM had several barriers that affected its implementation—acceptability issues due to distrust for government and the health system, health systems barriers including substandard health facilities and equipment, and inimical cultural and religious beliefs about health insurance.ConclusionThe study demonstrates a case for the implementation of innovative ADM as a strategy for enhancing SSHIS financial sustainability and coverage of persons in the informal sector. Hence, the strategy should be adopted in settings where philanthropy abounds for increasing access to quality healthcare delivery to poor beneficiaries toward achieving universal health coverage in developing countries.

Willingness to pay for haemodialysis among patients with chronic kidney disease in Abuja, Nigeria

“…Altruistic WTP could inform the design of a sliding scale premium in social health insurance schemes that ensure wealthier people pay more for services than less wealthy people [ 39 ]. The NHIA could also promote altruistic payment for haemodialysis by leveraging the adoption model in which altruistic individuals adopt people experiencing poverty and pay their annual social health insurance premium [ 40 ]. Evaluation of altruistic WTP for the entire population is warranted to ensure evidence informs the adoption model for haemodialysis.…”

Stakeholders’ Perspectives on the Financial Sustainability of the HIV Response in Nigeria: A Qualitative Study

“…46 support the HIV response in diverse ways, including through the SHI adoption model to pay for coverage of orphans and vulnerable children and poor populations. 47 The model is designed to target a pool of public-spirited individuals with a high net worth to pay premiums for low-income and vulnerable citizens, thereby increasing their access to prepaid health care. 47 A second option is to channel Zakat, a religious contribution, to the HIV Trust fund.…”

“…47 The model is designed to target a pool of public-spirited individuals with a high net worth to pay premiums for low-income and vulnerable citizens, thereby increasing their access to prepaid health care. 47 A second option is to channel Zakat, a religious contribution, to the HIV Trust fund. In addition, individuals can donate money for treatment adherence and nutrition support for PLHIV.…”

“…Nonetheless, the sustainability of domestic private donations is constrained by its lack of predictability in the amount of funding and lack of stability in terms of funding flow emanating from distrust for government programs. 47,48 Therefore, sustained advocacy and sensitization are required to improve the buy-in of philanthropists.…”

Willingness to pay for haemodialysis among patients with chronic kidney disease in Abuja, Nigeria

“…Altruistic WTP could inform the design of a sliding scale premium in social health insurance schemes that ensure wealthier people pay more for services than less wealthy people [38]. The NHIA could also promote altruistic payment for haemodialysis by leveraging the adoption model in which altruistic individuals adopt people experiencing poverty and pay their annual social health insurance premium [39].…”