Assessing responsiveness of health care services within a health insurance scheme in Nigeria: users’ perspectives

Abstract

BackgroundResponsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users’ perspectives of their health care services’ responsiveness.MethodsThis retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users’ perspectives on responsiveness to health services and quantify their effects.ResultsCommunication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as “extremely important” responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains.ConclusionsAssessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme’s implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve this responsiveness. For the Nigerian context, we suggest that health care providers in the NHIS should pay attention to these domains, and the associated characteristics of users, when delivering health care services to their clients. Policy makers, and the insurance regulatory agency, should consider the reform strategies of monitoring and quality assurance which focus on the domains of responsiveness to lessen the gap between users’ expectations and their experiences with health services.

Pattern and Physiotherapy Management of Shoulder Pain A 5-Year Retrospective Audit of a Nigerian Tertiary Hospital

“…With respect to health care funding, Nigeria government does not yet operate a full universal healthcare coverage. Conversely, out of pocket payment by patients is predominating while the national health insurance scheme that is in operation is predominantly targeted at Nigerian population employed in the formal sector of the economy [56]. Therefore, the present healthcare funding arrangement in placed may robbed appreciable segment of population of ease of access to desire healthcare services.…”

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“…It is a crucial aspect in the professional-user relation that fosters questioning about therapy and the disease. (10) Communication between professionals and users has also been satisfactorily evaluated in this study. Communication should break the barrier of information asymmetry, building new possibilities of understanding and solving the problems perceived.…”

“…However, the domains of autonomy, communication, and prompt care were identified as priority areas of action to improve the system's capacity of response. (10) Regarding the users' profiles, it was found that health services, notably the FHS, were more sought after by women, showing their concern about taking care of their health. Other reasons for increased adherence to and use of health services by women can be explained by the physiology and life cycles of women, which demand regular care.…”

“…Understanding, respect, kindness, non-discrimination and clearness are core aspects to services quality. (10) The FHS professionals' capacity to ensure confidentiality was positively assessed. Confidentiality refers to respect to privacy, and is a basic moral precept of health-related professions, implying the duty of safekeeping and preserving third parties' data/information.…”

“…In this way, the autonomy described herein involves participatory relations that contribute to the development of critical and demanding capacity among the social actors concerned. (10,13) Autonomy also depends on conditions external to the subject, even when s/he participates in the creation of such circumstances. Autonomy in the health field could be understood as self-care, defined as representations and practices used by populations to prevent, diagnose, explain, and heal processes that affect health without the direct intervention of professionals, although these last are the reference to self-care activities.…”