Barriers to enrollment in National Health Insurance Scheme among informal sector workers in Nigeria

Extending health insurance coverage to informal sector populations remains a major challenge toward achieving universal health coverage. This study aimed to fill the gap in the literature by examining barriers to enrollment in National Health Insurance Scheme (NHIS) among informal sector workers in Nigeria. Data were drawn from the 2018 Nigeria Demographic and Health Survey. The study population comprised of men (n = 10,163) and women (n = 22,216) working in the informal sector. Bivariate and multivariate logistic regression were used to examine barriers to enrollment in NHIS. Results show that the majority of men (98.9%) and women (98.6%) were not enrolled in NHIS. Age, gender of household head, educational level, socioeconomic status, geopolitical zone, distance to a health facility, frequency of reading newspapers or magazines, and watching television were significantly associated with non‐enrollment in NHIS. Findings suggest that enrollment in NHIS in Nigeria is very low. Additionally, there are significant barriers to enrollment. There is a need for governments and policymakers to address these barriers. The use of voluntary prepayments from informal sector workers as a strategy to extend health insurance coverage has not been effective. 摘要 尼日利亚非正式部门员工参加国民健康保险计划一事的阻碍 摘要:扩大非正式部门人口的健康保险覆盖，这仍然是实现全民健康保险的一大挑战。通过分析尼日利亚非正式部门员工参加国家健康保险计划（NHIS）一事所面临的阻碍，本研究旨在填补相关文献空白。研究数据源于2018年尼日利亚人口统计与健康调查。研究人群包括在非正式部门工作的男性（n = 10,163）和女性（n = 22,216）。使用双变量和多变量逻辑回归，分析参加NHIS所面临的阻碍。结果显示，大多数男性（98.9%）和女性（98.6%）没有参加NHIS。年龄、户主性别、教育水平、社会经济状态、地缘政治区域、与卫生设施的距离、阅读报纸或杂志的频率以及看电视的频率，与未参加NHIS显著相关。我们的研究结果表明，尼日利亚NHIS的参加率非常低。此外，参加NHIS一事面临重大阻碍。政府和政策制定者需要解决这些阻碍。使用非正式部门员工的自愿预付款作为扩大医疗保险覆盖率的策略并未奏效。 Resumen Extender la cobertura del seguro de salud a las poblaciones del sector informal sigue siendo un gran desafío para lograr la cobertura universal de salud. Este estudio tuvo como objetivo llenar el vacío en la literatura al examinar las barreras para la inscripción en el Esquema Nacional de Seguro de Salud (NHIS) entre los trabajadores del sector informal en Nigeria. Los datos se extrajeron de la Encuesta demográfica y de salud de Nigeria de 2018. La población de estudio estuvo compuesta por hombres (n = 10.163) y mujeres (n = 22.216) que trabajaban en el sector informal. Se utilizó regresión logística bivariada y multivariada para examinar las barreras para la inscripción en NHIS. Los resultados muestran que la mayoría de los hombres (98,9%) y las mujeres (98,6%) no estaban inscritos en el NHIS. La