Determinants of Community Members’ Willingness to Enroll and Pay for State Health Insurance in Six Nigerian States: Implications for Local Engagement in Health Security Financing
1
Medical Laboratory Services, University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria
2
Department of Public Health, University of Calabar, Calabar, Nigeria
3
University of Ibadan, Ibadan, Nigeria
4
Department of Medical Microbiology and Parasitology, University of Ilorin Teaching Hospital, Illorin, Nigeria
5
Faculty of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A1311
ABSTRACT
BACKGROUND:
Strengthening health insurance coverage is central to global health security, improving access to essential services and reducing financial vulnerability. Despite Nigeria’s decentralized insurance system, uptake of state schemes remains low. This study examined awareness, willingness to enroll (WTE), and willingness to pay (WTP) among uninsured adults across six Nigerian states.
METHODS:
A cross-sectional survey was conducted among 2,541 adults with no prior health insurance enrollment across six states (Oyo, Enugu, Cross River, Kwara, Sokoto, and Taraba).Data were collected on demographics, socioeconomic characteristics, insurance awareness, WTE, and WTP. Multivariable logistic regression identified determinants of WTP and WTE.
RESULTS:
Surprisingly, awareness of existing state health insurance schemes was often associated with lower willingness to participate, suggesting mistrust or dissatisfaction. Southern states had higher awareness (Oyo 64.1%; Enugu 59.9%) but low WTE (28.5%) and WTP (12.7–18.3%). Conversely, northern states such as Sokoto showed low awareness (24.7%) but high WTE (80.2%) and WTP (70.7%). Taraba recorded the highest WTE (85.3%) and strong WTP (62.0%). Income strongly predicted WTE and WTP in most states, particularly Oyo (AOR for WTP 5.92; 95% CI 2.25–15.58).
CONCLUSIONS:
Expanding health insurance coverage in Nigeria requires addressing financial barriers, gender disparities, household considerations, and public perceptions of existing schemes.
Strengthening health insurance coverage is central to global health security, improving access to essential services and reducing financial vulnerability. Despite Nigeria’s decentralized insurance system, uptake of state schemes remains low. This study examined awareness, willingness to enroll (WTE), and willingness to pay (WTP) among uninsured adults across six Nigerian states.
METHODS:
A cross-sectional survey was conducted among 2,541 adults with no prior health insurance enrollment across six states (Oyo, Enugu, Cross River, Kwara, Sokoto, and Taraba).Data were collected on demographics, socioeconomic characteristics, insurance awareness, WTE, and WTP. Multivariable logistic regression identified determinants of WTP and WTE.
RESULTS:
Surprisingly, awareness of existing state health insurance schemes was often associated with lower willingness to participate, suggesting mistrust or dissatisfaction. Southern states had higher awareness (Oyo 64.1%; Enugu 59.9%) but low WTE (28.5%) and WTP (12.7–18.3%). Conversely, northern states such as Sokoto showed low awareness (24.7%) but high WTE (80.2%) and WTP (70.7%). Taraba recorded the highest WTE (85.3%) and strong WTP (62.0%). Income strongly predicted WTE and WTP in most states, particularly Oyo (AOR for WTP 5.92; 95% CI 2.25–15.58).
CONCLUSIONS:
Expanding health insurance coverage in Nigeria requires addressing financial barriers, gender disparities, household considerations, and public perceptions of existing schemes.
| eISSN: | 2654-1459 |
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