Challenges in Accessing NHIA Services among Formal and Informal Sector Workers in Kano, Nigeria

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DOI: 10.21522/TIJAR.2014.12.04.Art008

Authors : H M Mijinyawa, Z Iliyasu

Abstract:

Nigeria’s National Health Insurance Authority (NHIA) aims to achieve universal health coverage (UHC), yet persistent inequities in access between formal and informal sector workers who constitute over 80% of the workforce remain poorly understood. The aim of this study is to compare challenges faced by formal and informal sector enrollees in accessing NHIA services in Kano, Nigeria, and identify systemic gaps to inform policy reforms. A cross-sectional comparative study of 440 NHIA enrollees (205 formal, 235 informal) across all 44 Local Government Areas in Kano State was conducted. Eligible participants were adults (≥18 years) enrolled for ≥6 months who had accessed care within the past 3 months. Data were collected via structured questionnaires and in-depth interviews. Primary outcomes included self-reported challenges in accessing NHIA services, analyzed by sector (formal/informal). Secondary outcomes included specific barriers (e.g., service codes, coverage limitations) and qualitative themes (e.g., operational delays). Chi-square tests assessed associations. Among 440 enrollees, 71.6% reported challenges, with informal sector workers disproportionately affected (87.7% vs 53.2%; χ²=64.03, P<0.001). Key barriers included difficulty obtaining service codes (38.0% informal, 41.4% formal), inadequate service coverage (9.6% vs 28.4%), poor customer service (12.2% vs 7.9%), and low awareness of benefits (14.6% vs 7.0%). Qualitative data highlighted operational inefficiencies (e.g., long wait times, unclear communication) as compounding factors. This study reveals significant disparities in NHIA access, with informal sector enrollees facing systemic barriers. Policy priorities should address administrative bottlenecks, expand service coverage, and strengthen community-based awareness campaigns to advance equitable UHC in Nigeria.

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