Health insurance and user fees: a survey of health service utilization and payment method in Mushin lga, Lagos, Nigeria

Background: Studies have documented how out-of-pocket payments (OOP) and user fees result in catastrophic health expenditures, providing evidence that health systems are better financed through prepayment mechanisms such as health insurance. Aim: This study sought to determine the perception of community residents to health insurance, their pattern of health service utilization and method and amount of payment. Methods: This descriptive cross-sectional study among 422 household members in Mushin LGA obtained data on sociodemographic characteristics, perception of health insurance, enrollment status and willingness to enroll; last use of health services and method of payment for health care services. Data analysis was done with Epi-info (ver 7) and results were presented as frequencies, percentages, means and standard deviations. Statistically significant associations were determined using the Chi-square test at significance level of p < 0.05. Results: Over half the respondents (56.6%) had not heard about health insurance. Very few (19.7%) were enrolled. Of those not enrolled, 57.1% were willing to consider buying health insurance. The method of payment for health services reported by respondents was OOP (98.3%). Those in younger age groups, with higher levels of education and higher household incomes reported having heard of health insurance. Higher educational level and household incomes were positively associated with willingness to enroll in a health insurance scheme. Conclusion: Awareness was insufficient, health services were paid for mostly from OOP. The authors recommend taking the opportunity to encourage uptake of health insurance for young adults and those in low- and middle-income households

Impact of performance-based financing on health-care quality and utilization in urban areas of Cameroon

This article looks at a pilot project designed to estimate the impact of performance-based financing (PBF) on the quality and utilization of health care in a predominantly urban setting - the Littoral region of Cameroon. It uses three quasi-experimental impact evaluation methods involving matching and difference-in-difference. Results show that the PBF pilot had a positive and significant impact on most essential aspects of quality of care. Meanwhile; there was no impact on any of the indicators of health service utilization with the exception (limited) of modern contraceptive methods. These findings suggest that the setting and indicators chosen are important in achieving maximum impact. However; it should also be noted that improvements in utilization might be limited as a result of high baseline figures. Finally; the findings show that the quality of care seems to be the most promising aspect in terms of improvements related to PBF in urban settings

Factors Responsible for Under-Utilization of Postnatal Care Services in Maiduguri; North-Eastern Nigeria

Background: In Maiduguri; the utilization of available postnatal care services is still very low. This may be influenced by demographic; socioeconomic; cultural; and obstetric factors among others. Objective: The aim of this study is to understand the current status of utilization of maternal postnatal health care services and identify factors responsible for under.utilization of available postnatal care services in Maiduguri. Materials and Methods: A. cross.sectional; questionnaire.based study was conducted involving 350 women in their reproductive age group. (15.49. years); who had delivered previously; residing in Maiduguri and who came to access any of the available maternal health care services at the State Specialist Hospital; Maiduguri over a 3.month period. The Chi.squared statistics and multivariate logistic regression analysis were used. Results: Out of the grand total of 350 questionnaires that were distributed during the study period; 18 questionnaires were excluded from analysis due to incomplete responses; 332 with complete responses were therefore analyzed; giving a response rate of 94.9. The results showed that only 16.9 of the respondents attended postnatal care services within 42. days after delivery. Most of the mothers. (60.9) were not knowledgeable about postnatal care services. A. very high proportion of participants. (69.4) did not attend antenatal clinics; and over. 70of the study population had delivered at home. The study has identified some factors that have an important influence on utilization of postnatal care services in Maiduguri. These included awareness of postnatal care services. (odds ratio. [OR] 12.04; 95 confidence interval. [CI]: 10.26; P =. 0.000); higher educational status of the woman. (OR 7.15; 95 CI: 5.19; P =0.000); lower parity. (OR 5.22; 95 CI: 3.21; P = 0.001) and marital status. (married woman.OR 3.44; 95 CI: 2.17; P =0.002). Educational attainment of the husband also significantly affected the respondents' seeking behavior of postnatal care. (OR 2.01; 95 CI: 1.13; P =0.042). Conclusion: Utilization of postnatal care services is quite low in Maiduguri. Socioeconomic and sociodemographic factors influenced the use of postnatal care services. Government should provide culturally acceptable health educational programs and expands maternal health care services into the communities for the better; effective and efficient health care delivery

Making a Difference with Vision 2020: The Right to Sight? Lessons from two States of North Western Nigeria

Settings and Aim: The World Health Organization launched in 1999 an initiative to eliminate the global avoidable blindness and prevent the projected doubling of avoidable visual impairment between 1990 and 2020 (Vision 2020: The Right to Sight). The World Health Assembly (WHA) adopted resolutions WHA 59.25; WHA 56.26 urging member states to adopt the Vision 2020 principles. More than 90 nongovernmental development organizations; agencies; and institutions; together with a number of major corporations; are now working together in this global partnership. Two neighboring states in North Western Nigeria provide eye care services using different approaches; one state uses the principles of Vision 2020; the other uses a different strategy. The aim of the study was to assess awareness and utilization of eye care services in two Nigerian states. Design: A population-based cross-sectional interview of households was conducted in two neighboring states using a structured questionnaire. Data analysis was performed using SPSS version 21 and a P 0.05 was considered as significant. Findings: Participation rate was 97 in the two states. The population in the Vision 2020-compliant state were significantly more aware about general eye care services (80 vs. 44; P 0.0005); had less proportion of households unaware of any eye care service (55 vs. 69; P 0.0005); and have a significantly higher felt the need to utilize eye care services (47 vs. 5.9; P 0.0005). The service utilization rate was however low in the two states. Conclusion: The principles of Vision 2020: The Right to Sight is adaptable to different cultures/societies and has demonstrated a potential to increase awareness and a felt need for eye care in poor resource settings

Utilization of Integrated Community Case Management Services in Three Regions in Ethiopia after Two Years of Implementation

Background: The integrated community case management (iCCM) strategy has brought fully integrated treatment for sick children to the community in Ethiopia since 2010. Objectives: To describe patterns of use of iCCM services in 31 woredas (districts) in three regions of Ethiopia. Methods: We analyzed all 60;452 encounters (58;341 [98.2] for children 2-59 months of age and 2079 [1.8] for children2 months of age) recorded in iCCM registration books from December 24; 2012 to January 15; 2013 in 622 randomly sampled health posts. Results: Children 2-23 months constituted more than half (58.9) of the total children treated; and about half of the registered infants 2 months (1000/2079 [48.1]) were not sick since some Health Extension Workers (HEWs) were recording well-infant visits. On average; sick children had 1.3 symptoms; more among children 2-59 months than among young infants (1.4 vs. 1.04; respectively). The main classifications for children 2-59 months were diarrhea with some or no dehydration (29.8); pneumonia (20.7); severe uncomplicated malnutrition (18.5); malaria (11.2); and other severe diseases (4.0). More than half the sick children 2 months (52.7) had very severe disease. Treatment rates (per 1000 children per year) were low for all classifications: 11.9 for malaria (in malarious kebeles only); 20.3 for malnutrition; 21.2 for pneumonia; and 29.2 for diarrhea with wide regional variations; except for pneumonia. Nearly two-thirds of health posts (64) treated 5 cases/month; but one treated 40. Health Extension Workers saw 60 more sick children 2-59 months in the third quarter of 2012 than in the third quarter of 2011. Conclusion: The use of iCCM services is low and increasing slowly; and the few busy health posts deserve further study. Recording healthy young infants in sick registers complicates tracking this vulnerable group

The impact of advocacy and community mobilization on the utilization of health services at the Comprehensive Health Centre, Gindiri

Primary Health Care facilities provide promotive; preventive; curative and rehabilitative services to a community. They may be well built and equipped with adequate resources but grossly underutilized due to several factors. Health records at the Comprehensive Health Centre Gindiri for 2005 were compared with those of 2007 after a well-coordinated advocacy and mobilization programme in that community. The results show that the total out patient attendance in 2007 increased by 220.6 when compared to that of 2005. 293 patients were admitted into the wards in 2005 compared to 813 in 2007(277). There was no surgery carried out in the whole of 2005; whereas in 2007 there were 98 surgeries. Advocacy and community mobilization could be important factors in the utilization of primary health services