Determinants of Community-Based Health Insurance Enrolment in Africa: Reflections from Rural Nigeria

Community-Based Health Insurance (CBHI) in the recent decades is being promoted in the Low-and-Middle Income Countries (LMICs) as an effective alternative model for accessing healthcare services among the poor. Cost of accessing care under the programme is comparably cheaper, and it is also seen as a means towards attaining Universal Healthcare Coverage (UHC). This is being promoted due to the perceived inefficiency of the primary healthcare system in most developing countries. However, healthcare services can only be accessed under such programme by those who enrol in it. This study, therefore, examines the determinants of CBHI enrolment in rural Kwara in Nigeria. The study adopted mixed methods research design. A total of 1,583 questionnaires were administered, and 33 in-depth interviews were conducted in the study area. SPSS and Atlas.ti were adopted for quantitative and qualitative data analyses respectively. Findings reveal that although the programme has received considerable patronage, but since access to healthcare under CBHI is not free, enrolment remains a contentious issue of discourse based on its importance to the success of the policy option. The study concludes that the government must take responsibility by financing access to healthcare especially for those who lack affordability.