1.1 Background to the Study
Maternal health is crucial to the production and survival of healthy children in any society. It is often said that ‘health is wealth’. Applying this aphorism to maternal health, it means that the quality of maternal healthcare received by the nursing mothers helps in the production of future healthy population and the wealth of any nation (Kwanga, Kirfi, & Balarabe, 2013; WHO, 2005). Health has been defined by the World Health Organization (WHO) as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”(WHO, 2011). Incidentally, Likewise, Irinoye (2007) defined health as encompassing “a state of physical, mental and social well-being in which the individual is able to lead a full effective life, unimpeded by mental or physical disabilities or frustrations”. Hence, Mmaternal health care will then translate to the ability to provide necessary medical care for nursing mothers in order to prevent mortality and morbidity of both mother and the child(ren).
Health care system is inundated with funding challenge in the developing countries to which African countries belong,(Owumi, Omorongbe, & Raphael, 2013). Nigeria is not an exception to this identified challenge faced by the health sector. Instructively, Tthe downturn in the oil price in the world market in the 1980s led to a considerable underfunding of the health care sector by the federal government of Nigeria, (Odeyemi & Nixon, 2013; Okaro, Ohagwu, & Njoku, 2010; Oyekale, 2012). Another factor that can be traced to the underfunding of the health sector is the population upsurge in the country, (Irinoye, 2007). These constraints have is has reduced the quality of service; and made health inaccessible to a considerable number of Nigerians who are confronted with issues of poverty. Importantly, It has been revealed that Nigeria has recorded high mortality and morbidity rates when compared with other countries of the world, (Adeoye, Onayade, & Fatusi, 2013).
In response to the sordid condition of health care in the country, institutionalizing health insurance was a means adopted by the Federal government of Nigeria to deal with the challenges of mortality and morbidity in the country. In the light of the foregoing, NHIS came into being as a means funding and providing health care to the people in the country. In accordance with Act 35 of the 1999 NHIS Decree, NHIS was established in Nigeria with the major objective of increasing the accessibility to quality, equitable and affordable health care by all the citizens of the country. Although, the enactment that established the scheme was signed in 1999, the effective implementation of the scheme did not occur until 2005, (Irinoye, 2007).
The implementation of the National Health Insurance sScheme has raised issues that have undermined the objective of the scheme. This is because 5% of the population of the country are registered on the scheme, (Yusuf & Akinmola, 2009). Disappointingly,Likewise, some state governments in the country are yet to implement the scheme for their workers, (Eboh, Akpata, & Akintoye, 2017). For example, as revealed in the statement of the Executive Governor of Osun state, His Excellency, Adegboyega Oyetola, in May 2019, NHIS has not been implemented for the state government workers of the sState of Osun., (Nasir, 2019). This is in sharp contrast with the original goals of the NHIS, thatNHIS, which is, increasing accessibility to health care for all Nigerians. As a result of the exclusion of some Nigerians from the Scheme, it might be difficult to achieve the goals of the scheme. Owing to the anomalies stated above and few others, the scheme, in its current state of implementation would not achieve the goals for which it was set.
Maternal mortality rate in Nigeria before the effective implementation of the NHIS in 2005 was estimated at 940 per live births for the same year 2005, (WHO, 2015)..Also, Mmortality rate for the “under-five children” was 198 per live births in 2003, (WHO, 2005). By 2015 (ten years after the commencement of the NHIS), Comparatively, ten years after the implementation of the NHIS, 2015 to be precise, statistics have shown that mortality rates are estimated as follows: maternal mortality was 814 per 100,000 live births, (WHO, 2015) and mortality rate of the under-five children was put at 108.8 per 1000 live births, (UNDP, 2016). From these statistics, It is clearly revealed that there is a decline in the both maternal mortality rate and under-five children mortality rate in Nigeria. However, it is difficult to conclude that this reduction can be associated with the success of the NHIS. Painfully, Even with the decline, Nigeria still records one of the frightening mortality rate in the world. is still found among the countries which contribute most to the mortality of the world at large. Furthermore, it is worthy of note that studies have not actually concluded that it is the implementation NHIS that resulted to the reduction in the mortality rate in the country.
Studies on NHIS are mostly focused on the attitude of public workers or enrollees to the scheme. However, women constitute a critical force to the survival of any society. This is not in isolation of the fact that women constitute half of the population of the country. More significantly, reproduction in any society cannot take place without women, nursing mothers especially. It should be noted that for women to give birth to healthy children, access to health care by the nursing mothers is important. must be attended to. It is in appreciation of this fact that it becomes pertinent to interrogate the operations of the NHIS. In the light of the foregoing, in order to increase the accessibility to health care as stated by the goal of the NHIS, the implementation of the scheme must be looked at beyond its present state. Consequently, this study would interrogate the focus on the attitude of nursing mothers to the NHIS.; and interrogate if the scheme has been helpful in reducing mortality amongst women and children.
1.2 Statement of Problem
The NHIS , according to its objective is meant to increase the accessibility to health for Nigerians with a view to reducing equitable, quality and affordable healthcare for the people, thereby raising the level of healthy living and reducing the mortality and morbidity rates in Nigeria. It is also the right of every citizen to be able to access quality health care and at affordable cost. However, the reality is that the NHIS has been constrained from achieving the objectives for which it was set up. But this scheme has been hindered so many issues. There are a number of issues concerning the quality of healthcare or the services provided by Health Care Providers (HCPs) under the provisions of the NHIS.
Several studies have been carried out to examine the effectiveness of the NHIS in carrying out its objectives. First, a number of studies are centered on the relationship between awareness level and the usage of the scheme, (Adewole, Dairo, & Bolarinwa, 2016; Eyong, Agada, Asukwo, & Irene, 2016; Okaro et al., 2010; Oyekale, 2012). Some studies have also investigated the enrollees level of awareness and knowledge of the policies and rules of the (Okaro et al., 2010; Yusuf & Akinmola, 2009). Furthermore, poor coverage of the NHIS among the populace has been identified as a critical limitation of the scheme (Adewole et al., 2016; Eboh et al., 2017; Ibiwoye & Adeleke, 2008). Quality of service provided to the enrollees is another issue that requires attention (Asakitikpi, 2016; Daramola, Adeniran, & Akande, 2018; Oladipupo, Lanre, & Oluwatosin, 2017; Yusuf & Akinmola, 2009). It has also been revealed that the coverage of NHIS favours the people in formal employment than those in the informal employments, (Ibiwoye & Adeleke, 2008). In relation with the quality of service provided by the scheme to the users, Oladipupo et al. (2017) revealed that 45% of its study respondents were dissatisfied with the service delivered by the scheme. The reason for this dissatisfaction was further explained as unavailability of drugs, long waiting periods, referral issues, as well as registration procedure. Ibiwoye & Adeleke (2008) stated that 60% of its respondents encountered problem, and are displeased with the NHIS services or operations based on such issues as long queues and poor reception given them by some unfriendly health workers. Comment by user: This could come in your review of literature or in the analysis of your data.
The gap in literature is that sufficient attention has not been paid to the attitude of nursing mothers to the Scheme. Inferring from this argument, one can say that no particular attention has been paid to the view of the nursing mother on the scheme. It should also be noted that nursing mothers have been regarded as part of the vulnerable population as far as health accessibility is concerend, especially mortality and morbidity rates is concerned, (Oyibocha et al., 2014). As a result of the challenges that plague the operations of the NHIS, some pregnant and nursing mothers are excluded from accessing the NHIS. The consequence of this for those pregnant and nursing mothers is to make use of In a bid to access the health care, the nursing mothers, who may not be able to afford the costly out-of-pocket means of funding healthcare, may turn to other options which include self-medication, traditional medicines, and faith homes.The consequence of this for mortality and morbidity for women and the society is better imagined than being described. , patronage of the incompetent health practitioners. This in turn, if not nipped in the bud, might increase mortality and morbidity rates among the nursing mothers and their wards in the country. This may have adverse effect on the economy of the country in two ways. First, the working population may be reduced as result of sickness or and death, which has the ability to reduce the national production capacity and by implication, national income. Also, the government may have to spend its meager resources on curative rather than preventive care for its citizens. Secondly, the country may have to spend her insufficient income on curative care for the sick citizens in the long run.
1.3 Research Questions
- What is the attitude of nursing mother enrollees to the scheme in public and private accredited NHIS facilities?
- What are the gaps in the operations of the NHIS that could hinder the scheme from achieving its mandate?
- What is the assessment of nursing mother enrollees of the quality of service offered by the NHIS accredited hospitals?
1.4 Objectives of the Study
The general objective of this study is to investigate the attitude of nursing mothers towards the operations of the NHIS in accredited facilities in Ile-Ife. Inferring from the general objectives, are the specific objectives:
- Investigate the attitude of nursing mothers to the scheme in both public and private NHIS accredited hospitals;
- Identify the gaps in the operations of the NHIS that could hinder the scheme from achieving its mandate;
- Investigate the quality of the service provided by the scheme to the nursing mothers; and
- Make evidence-based suggestions to strengthen the scheme.
1.5 Justification of The Study
In order to reduce mortality and morbidity rate in the country, it is important to interrogate the operations of the NHIS with a view to strengthening it. If the country is to have a healthy productive force, it becomes pertinent to make health more accessible to pregnant and nursing mothers. This study would draw its conclusions from the narratives of both pregnant and nursing mothers to suggest empirically based suggestions that would strengthen the operations of the NHIS.
In conclusion, the study would identify the problems that are associated with the operations of the NHIS, which has made some pregnant women and nursing mothers to find it difficult to access the NHIS. In order to identify the efficiency of the NHIS, the evaluation of the scheme needs to be done using the right yardstick and measures.Nursing mothers are important in the reproduction of every society. The reason is not disconnected from their responsibility of carrying pregnancy and also take custody of the infants and under-five children in most cases. Hence, their views about the scheme, which have not really been explored in the assessment of NHIS. Whatever conclusion that is drawn by this study will be based on the views of the nursing mothers of the NHIS and its functioning.
On the other hand, this study will provide a conclusion and recommendation which will be rooted in the context and evidence-based data that would highlight the experience of the nursing mother in accessing NHIS.
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