Evidences show that the health system in Nigeria and the health status of Nigerians are in a deplorable state (NDHS 2008, WHO 2008a). Apart from its very high mortality and morbidity indices, the health system is also typified among others by low budgetary and inefficient resource allocation within the levels of care, high user fees in public and private health facilities, high out-of-pocket expenditure, and little or no safety net for poor and rural-based dwellers in the informal sector. Like in Nigeria, the health statistics of Gombe State in which the Kaltungo Local Government Area is a constituent part is also epitomized by inequalities in health care and poor health indices. It was in the bid to remedy the situation and to ensure that every Nigerian has access to good health care services that the Federal Government established the National Health Insurance Scheme (NHIS) through the promulgation of Act 35 of 1999.
Despite the myriad of benefits that can accrue to a community through the establishment of CBHIS, the scheme is yet to fully take off in Gombe State in general and in Kaltungo LGA in particular. It is within this context that the overall objective of the feasibility study is to provide information that will enable policy makers and other stakeholders take an informed decision on the establishment of CBHIS in Kaltungo LGA of Gombe State.
The methodology adopted in the feasibility study involved both qualitative and quantitative analysis. Household surveys, focus groups discussions and key informant in-depth interviews were employed to source the primary data used in the analysis. Secondary data will be collected to complement the primary data and analysis. The mean willingness-to pay (WTP) per person per month was 273.0 ± 180 naira and the average household members the respondents were willing to pay for was 5. The household size (p=0.02), formal education (p=0.039), perceived health status (p=0.004) and health care expenditure (p=0.023) are key determinants of WTP. Since CBHIS in Kaltungo is to provide financial protection for the socially marginalized and vulnerable groups, such as the poor, women, children and the elderly, then the health insurance contribution should be set not more than 30% of the mean non-subsistence expenditure. Otherwise, households will experience serious financial hardship in satisfying other non-food expenditures like education, housing, transport with indirect impact on household health status.
This study showed that implementation of a CBHI scheme in Kaltungo is feasible, given that 100% of all interviewees were willing to join the proposed CBHI scheme. However, the success of the proposed CBHIS in Kaltungo and the ability of the program to make strides in achieving the state’s ultimate goal of universal health coverage fundamentally depend on good administrative and management capacity for coordination of payments, premium collection and contracting of the provider, political commitment to subsidization and timely release of funds, strong community trust and establishment of health development trust fund for subsidy and income generating activities for the communities.