Implementing Community Based Health Insurance Schemes: A Mechanism for Health Care Service Delivery in Kano Metropolis

The lethargic nature of the Nigerian health system, ravaged by numerous operational and administrative crises, had necessitated the establishment of National Health Insurance Scheme (NHIS) as one of Nigerian government’s health reform measure aimed at securing better health care for Nigerians. However, only the formal sector insurance scheme was fully operational while the informal sector scheme like Community Based Health Insurance Schemes (CBHIS) was not implemented particularly in Kano state and other Northern States where it is much needed. This study aimed at identifying how the implementation of CBHIS would ensure the actualization of NHIS major objectives, the challenges affecting its implementation and the politico-economic implications of both these challenges and the scheme itself. Mixed method approach where both qualitative and quantitative data were utilized. The qualitative data was obtained from in-depth interviews with relevant stakeholders such as traditional, religious, women and Youth leaders. The National Health Insurance Agency officials, health management organizations, and Civil Society Organizations were also interviewed. Quantitative data was obtained through the administration of questionnaires to healthcare enrollees of the NHIA and the Leaders of selected community based associations in the State. Quantitative data was analysed using frequency and percentage tables and qualitatively through selected themes relevant to the study. Findings revealed that the health situations of many in the communities are ravaged by many challenges ranging from inadequate finances (poverty), proximity issues, poor road networks, poor state of health facilities, inadequate drugs, adverse government policies, inadequate support from the government, lack of knowledge on the Islamic position of insurance among others. Additionally, findings revealed that the CBHIS is built on the premise of reducing existing gaps of inequality in access to quality healthcare and a financing strategy, yet its implementation is blurred by numerous challenges such as poor awareness about the scheme, low level of acceptance, poor government commitment, lack of trust on both government and board of trustees on the part of community members among others. The study concluded that, CBHIS would have served as the best health financing option that would strengthen community support for health care needs of members and help accepting health care financing as a collective responsibility of government and the community.