Quality Improvement in Osun State Healthcare Delivery: A Cross-sectional Study on Perceived Operational Challenges with the Osun Health Insurance Scheme (OHIS) by Accredited Providers

Background: Access to quality healthcare is still a challenge for most Nigerians due to poor healthcare financing. Osun Health Insurance Scheme (OHIS), established to bridge the healthcare gap of the citizens, has been faced with operational challenges which require continuous efforts to mitigate. This study aimed to identify factors affecting the operation of OHIS across accredited health facilities. Methods: This cross-sectional study was conducted in July to September 2024, among medical directors, physicians, and OHIS desk officers at OHIS-accredited healthcare facilities in Osun State. A self-administered questionnaire was used for data collection while analysis was done using the Statistical Package for Social Sciences, Version 23.0. The level of statistical significance was set as p-value < 0.05. Results: Findings showed that although 84% of respondents reported good knowledge of OHIS, gaps existed across various domains in understanding its goals, operations, and clinical and laboratory services. Predictors of knowledge included facilities being privately owned. The common operational challenges identified were poor enrollees’ understanding of insurance plans and expectations (77.6%), low reimbursement fees (70.4%), delay in claims processing and payment (57.6%), low patient volume (57.6%), improper distribution and allocation of enrollees (52.8%), misconduct by enrollees (52.8%), inadequate funding of the scheme (48%) and inadequate power supply (44.8%). Conclusion: The findings show limited awareness of OHIS goals, processes, and services among workers in accredited facilities, suggesting an even worse situation in the general population. Operational challenges were also identified, highlighting the need for coordinated actions by stakeholders.