Community Participation and Strategic Frameworks for Advancing Health Insurance Coverage in Katsina State
Abstract:
Universal Health
Coverage (UHC) remains elusive in Nigeria, particularly in Katsina State, where
less than 10% of the population has health insurance and 70% pay for care
out-of-pocket amidst deep poverty. This paper examines how community
participation and strategic policy frameworks can expand insurance coverage,
focusing on Community-Based Health Insurance (CBHI) as a potential vehicle.
Employing a qualitative case study design, this research draws on Focus Group
Discussions with community leaders, residents, and health officials across four
diverse communities in Katsina State to explore local perceptions and barriers.
The findings reveal that while significant challenges—including low awareness,
deep-seated mistrust in formal institutions, and concerns over premium
affordability—hinder uptake, there is a strong willingness to pay for CBHI.
However, this is contingent on transparent, community-led management and the
availability of pro-poor subsidies. Based on these results, the study proposes
a multi-faceted strategy centered on intensive public awareness, subsidized
premiums for low-income residents, strengthening the Katsina State Contributory
Healthcare Management Agency (KATSCHMA), and genuine community involvement in
the design and governance of insurance plans to build trust and ensure
sustainability.
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