Satisfaction and retention among NHIS enrollees at a tertiary hospital in Ebonyi State, Nigeria: facility-based insights for community-based health insurance policy

This single-centre mixed-methods study shows that while nearly two-thirds of NHIS enrollees were satisfied with the quality and affordability of scheme-provided services, persistent service-delivery gaps and administrative bottlenecks undermine retention intentions. Policy adjustments that prioritise improving service delivery, addressing administrative inefficiencies and strengthening provider-patient relationships are likely to enhance satisfaction and retention within the NHIS. These findings also offer practical insights for the design and scaling of community-based health insurance and related service-delivery reforms in similar mixed urban-rural settings, and for advancing equity-focused progress towards universal health coverage and related Sustainable Development Goals.