Facilitators and Barriers to Nurses’ Participation in the National Health Insurance Scheme at a Teaching Hospital in Southeast Nigeria

Background: The National Health Insurance Scheme (NHIS) was established in Nigeria to improve healthcare access and reduce out of pocket expenditure. However, participation among healthcare professionals, particularly nurses, remains suboptimal. Understanding the facilitators and barriers affecting nurses’ involvement is critical for strengthening the scheme.
Objective: To identify facilitators promoting participation and to assess individual and organizational barriers hindering participation among nurses at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Awka, Anambra State.
Methods: A cross-sectional survey was used to conduct a descriptive survey on 184 registered nurses who were chosen through multistage sampling. The structured validated questionnaire was used to collect the data. The SPSS version 28 was used to analyze the descriptive statistics such as means, frequencies, and percentages. The scale was a 5 points Likert scale with the mean scores of 3.41 and above being regarded as agreement.
Results: Most of the respondents were women (61%), with an age between 28 and 37 years (37%), and a Bachelor of Nursing Science degree (50%). The main facilitators were the realization of the benefits of NHIS to the healthcare system, better access to care by patients and the sense of being valued in the implementation of NHIS policies. The significant personal obstacles included lack of involvement in decision making, heavy work load, and lack of incentives. Organizational obstacles comprised of insufficient provision of medicines and equipment, bad grievance systems, and protracted enrolment processes.
Conclusion: Although nurses recognize the advantages of NHIS, there are major personal and organizational obstacles that curtail their involvement. To achieve universal health coverage in Nigeria, it is necessary to address workload problems, offer incentives, enhance drug supply, and engage nurses in decision making.

National Health Insurance Scheme, nurses, facilitators, barriers, Nigeria, NHIS, universal health coverage

1. Akinyemi, O. O., Owopetu, O. F., & Agbejule, I. O. (2021). National Health Insurance Scheme: Perception and participation of federal civil servants in Ibadan. Annals of Ibadan Postgraduate Medicine, 19(1), 49–55. https://pubmed.ncbi.nlm.nih.gov/35330897/ [Google Scholar] [Crossref]

2. Alawode, G. O., & Adewole, D. A. (2021). Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: A qualitative study among sub-national level actors, healthcare and insurance providers. BMC Public Health, 21, 124. https://doi.org/10.1186/s12889-020-10133-5 [Google Scholar] [Crossref]

3. Alhassan, R. K., Nketiah-Amponsah, E., & Arhinful, D. K. (2016). A review of the National Health Insurance Scheme in Ghana: What are the sustainability threats and prospects? PLoS ONE, 11(11), e0165151. https://doi.org/10.1371/journal.pone.0165151 [Google Scholar] [Crossref]

4. Barasa, E. W., Manyara, A., Mwangi, N., & Molyneux, C. (2018). A critical analysis of purchasing arrangements in Kenya: The case of the national hospital insurance fund. International Journal of Health Policy and Management, 7(3), 244–254. https://doi.org/10.15171/ijhpm.2017.83 [Google Scholar] [Crossref]

5. Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Sage Publications. [Google Scholar] [Crossref]

6. Eze, O. I., Iseolorunkanmi, A., & Adeloye, D. (2024). The National Health Insurance Scheme (NHIS) in Nigeria: Current issues and implementation challenges. Journal of Global Health Economics and Policy, 4, e2024002. [Google Scholar] [Crossref]

7. Fenny, A. P., Asante, F. A., & Agyepong, I. A. (2021). Provider payment mechanisms in Ghana's National Health Insurance Scheme: A review of the evidence. Health Policy and Planning, 36(6), 945–956. https://doi.org/10.1093/heapol/czab031 [Google Scholar] [Crossref]

8. Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education Quarterly, 11(1), 1–47. [Google Scholar] [Crossref]

9. Kapologwe, N. A., Mshana, G., & Kalolo, A. (2020). Challenges of community health insurance in Tanzania: A qualitative study of provider and consumer perspectives. BMC Health Services Research, 20, 212. https://doi.org/10.1186/s12913-020-05092-1 [Google Scholar] [Crossref]

10. Mladovsky, P., Ndiaye, Y., & Ndiaye, A. (2022). Social health insurance and provider participation in sub-Saharan Africa: A systematic review. International Journal for Equity in Health, 21, 45. https://doi.org/10.1186/s12939-022-01645-8 [Google Scholar] [Crossref]

11. NIH (National Institutes of Health). (2024). Patient satisfaction with quality of care in NHIS clinic in a federal tertiary hospital in Southwest Nigeria. Nigerian Medical Journal, 65(5), 725–736. [Google Scholar] [Crossref]

12. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). McGraw-Hill. [Google Scholar] [Crossref]

13. Oladugba, A. O., Okafor, C. E., & Nwosu, I. P. (2024). Awareness, knowledge and participation in the National Health Insurance Scheme among nurses in a tertiary hospital in Southeastern Nigeria. International Journal of Nursing and Midwifery, 16(2), 45–53. https://doi.org/10.5897/IJNM2024.0623 [Google Scholar] [Crossref]

14. Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what's being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489–497. [Google Scholar] [Crossref]

15. Premium Times. (2025). Nigeria's health financing still far below target despite progress – Minister. [Google Scholar] [Crossref]

16. Radio Nigeria. (2025). NHIA hits milestone with 20m Nigerians covered under Health Insurance. [Google Scholar] [Crossref]

17. The Guardian. (2024). NHIA reports 40% increase in health insurance coverage in one year. [Google Scholar] [Crossref]

18. Tribune Online. (2025). NHIA expands universal health coverage for enrollees — Dr. Ohiri. [Google Scholar] [Crossref]

19. Uzochukwu, B. S., Ughasoro, M. D., & Etiaba, E. (2020). Health financing in Nigeria: A review of challenges and opportunities. Nigerian Journal of Clinical Practice, 23(6), 765–773. [Google Scholar] [Crossref]

20. World Bank. (2024). Out-of-pocket expenditure (% of current health expenditure) – Nigeria. [Google Scholar] [Crossref]

21. Yamane, T. (1967). Statistics: An introductory analysis (2nd ed.). Harper & Row [Google Scholar] [Crossref]

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