ABSTRACT
Its widely acknowledge that the performance of a national health system is largely
determined by its financing mechanism. Hence, the Federal government through the
NHIS is implementing a social health insurance programme and hopes to achieve a more
flexible, more innovative and more competitive response to the health sector in order to
ensure that every Nigeria has access to quality healthcare, that families are protected from
the financial hardship of huge medical bills, ensure equitable distribution of healthcare
costs among different income groups, improve and harness private sector participation in
the provision off health services, equitable distribution of healthcare facilities within the
federation, ensure availability of funds to the health sector for improved services.
The study was conducted to assess the Knowledge and quality of outpatient care from
the perspective of the NHIS clients, health providers and health managers under the
scheme at Barau Dikko Specialist Hospital Kaduna. Five years after the commencement
of the scheme, although the level of awareness is very high, 41.7% of the NHIS enrollees,
48.6% of the healthcare providers and 55.6% of the healthcare managers of the facility
were knowledgeable on various aspects of the operation of NHIS. The NHIS enrollees and healthcare providers of the facility rated positive staff attitude, adequate
information/communication about services and technical competence of the healthcare
provider as the most important quality indicator in the outpatient care whereas the
healthcare managers are looking at quality of care in the direction of improved funding,
provision of physical infrastructure and having adequate trained personnel. Majority of
the enrollees said that past experience and high expectations are the main reasons for
choosing the hospital during registration. The of rate utilization of outpatient care of 38%
per annum by NHIS clients shows some improvement while the pattern of utilization is
more of re-visit with the referrals very low. The level of NHIS enrollees' satisfaction
with outpatient care services in facility is 43%. The awareness of the existence of the
scheme was very encouraging; however, this was not translated into knowledge of the principles of the operation of the scheme, these therefore call for an aggressive publicity
drive and intensive educational campaigns. This study showed that client satisfaction
with outpatient care under NHIS is largely determined by the knowledge of the
rudimentary principles of the operation of the scheme.