The Perceived Impact of National Health Insurance Authority on Infrastructural Development among Healthcare Workers in Selected Healthcare Facilities in FCT, Abuja

Introduction: Infrastructure is critical to healthcare delivery, and while financing via the National Health Insurance Authority (NHIA) advances UHC through better service access, its underfunding- marked by high out-of-pocket expenses, low capitation, quarterly deficits, and HMO inefficiencies yields minimal perceived infrastructural progress in FCT facilities.

Objectives: This study intends to investigate the perceived impact of the National Health Insurance Authority on infrastructural development in selected healthcare facilities in Federal Capital Territory.

Method: A cluster sampling technique was employed to select 30 healthcare facilities from the 152 NHIA- accredited facilities in the FCT. The selection of facilities was conducted through simple random procedures, thereby giving all accredited facilities—public, private, and public-private—an equal probability of selection. This process resulted in a sample comprising 4 public, 25 private, and 1 public-private facility. Following the selection of clusters (facilities), proportionate sampling was applied to choose the respondent. Cochran’s formula was used to determine the required sample size, and an equal allocation of 12 respondents per facility was adopted to ensure consistency across clusters. This produced a total sample size of 360 respondents across the 30 selected healthcare facilities. Data was collected from healthcare workers in the facilities using a structured questionnaire. The five-section questionnaire included two self-developed sections capturing healthcare workers’ demographics and facility infrastructure, while sections adapted from Hassan (2022) assessed the NHIA’s impact on service delivery, enrollee access, and infrastructure, as well as barriers to fund use and implementation. Responses were measured using a four-point Likert scale ranging from strongly agree to strongly disagree.

The questionnaires were analyzed using Statistical Package for Social Science (SPSS), and descriptive statistics was used to summarize the qualitative data using proportions and frequencies, ordinal regression analysis was employed to test the hypotheses

Result: The study found that 58.6% of health workers perceive that the NHIA has no impact on infrastructure development in healthcare facilities, while 68.6% believe it positively influences healthcare delivery services. Despite this, 84.1% of participants report deficits after quarterly payments. Additionally, 75.6% of healthcare workers face barriers in utilizing funds, and 76.4% report challenges in implementing NHIA. Major obstacles include low capitation, fee-for-service issues, and HMO inefficiencies, as reported by 63.4% and 56.3% of healthcare workers.

Conclusion: The study shows that while the National Health Insurance Authority (NHIA) has improved access to basic healthcare services and increased enrollee participation, due to an extensive implementation of the Basic Minimum Package of Health Services, including a robust benefit package, its impact on facility infrastructure and operational efficiency remains limited because providers barely have any funds left to maintain or upgrade


infrastructure. Variability in model fit suggests that barriers to implementation differ across facility types, with public and private providers both constrained by delayed payments, low tariffs, and administrative inefficiencies.

National Health Insurance Authority (NHIA)

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