EFFECTIVENESS OF THE NATIONAL HEALTH INSURANCE SCHEME (NHIS) IN IMPROVING ACCESS TO MATERNAL HEALTHCARE AMONG CIVIL SERVANTS IN FEDERAL TERTIARY INSTITUTIONS IN KOGI STATE, NIGERIA

Abstract

Accessing quality maternal healthcare remains a critical public health concern in Nigeria, despite several policies and interventions introduced over the decades. The National Health Insurance Scheme (NHIS) was initiated to improve healthcare access and reduce out-of-pocket expenditure among Nigerians, particularly among public sector workers. Anchored in the Health Belief Model (Rosenstock, 1974) and Andersen's Behavioural Model of Health Services 
Utilisation (Andersen, 1995), this study examines the effectiveness of the NHIS in improving access to maternal healthcare services among civil servants in three federal tertiary institutions in Kogi State, Nigeria. Adopting a descriptive survey design within a concurrent mixed-method framework, the study focused on female civil servants of reproductive age enrolled in the NHIS. Quantitative data were collected from 351 respondents through structured questionnaires, while qualitative data were obtained through in-depth interviews with 20 female civil servants and three healthcare providers in NHIS-accredited facilities, with both strands collected simultaneously and merged at the point of interpretation. Quantitative data were analysed using descriptive statistics, Pearson Product Moment Correlation (PPMC), and regression analysis, while thematic analysis was deployed for qualitative responses. Findings showed a high level of awareness of the NHIS among respondents and a moderate-to-high improvement in access to maternal healthcare services. However, significant challenges such as limited coverage of certain maternal health services, administrative delays, and inadequate 
numbers of accredited health facilities persisted. All three null hypotheses were rejected at p < 
.05, confirming significant relationships between NHIS enrolment, awareness, and utilisation 
of maternal healthcare services. The study recommends expanded benefit packages, 
streamlined administrative processes, increased accreditation of health facilities, and sustained 
awareness campaigns to improve maternal health outcomes under the NHIS.