The project on the topic evaluation of the effect of natural health insurance scheme in enhancing health care delivery in Enugu metropolis was discussed chapter by chapters. First in the introduction was attempt of adopting a health insurance system in Enugu and also to look into starting a health insurance system in Nigeria. Which the future benefit is bright. The statement of the problem were looked into the failure to understand the significant contribution of effective and efficient national health insurance scheme in Enugu. Further, some materials previously written on this topic were reviewed to come up with recent information concerning this project like in chapter four the researcher enumerated the following findings as concerned the work and went ahead to discuss those findings. Finally, the project work ended with conclusion and recommendation, where it was recommended that the percentage of the effect and efficient of national health care insurance scheme should increase to attract more good health.

TABLE OF CONTENT

Title page - - - - - - -- - - - ii

Approval page- - - - - - - - - - iii

Dedication - - - - -- - - - - - iv

Acknowledgement - - - - - - - - - v

Abstract - - - - - - - - - - - vi

CHAPTER ONE

INTRODUCTION

1.1 Background of the study- - - - - - - 1

1.2 Statement of the problem - - - - - - 4

1.3 Objective of the study - - - - - - - 4

1.4 Research questions - - - - - - - - 5

1.5 Significance of the study- - - - - - - 6

1.6 Scope and limitation of study- - - - - - 7

1.7 Definition of terms - - - - - - - - 8

Reference- - - - - - - - - - -12

CHAPTER TWO

2.1 REVIEW OF RELATED LITERATURE

2.2 Historical development of national health

insurance scheme - - - - - - - - - 13

2.3 The concept of national health insurance

scheme in Nigeria - - - - - - - - - 16

2.4 Objectives of national health insurance scheme - - 18

2.5 Benefits of national health Insurance scheme- - - 20

2.6 Types of health insurance scheme - - - - - 23

2.7 How the scheme operates in Nigeria - - - - - 25

2.8 Strategies/implementation action to enhance

National health insurance scheme in Nigeria - - - - 29

2.9 Guideline for effective NHIS in Nigeria - - - - 31

2.10 problems of national health insurance

scheme in Nigeria -- - - - - - - - - 36

2.11 challenges facing effective marketing of NHIS - - - 39

Reference - - - - - - - - - - 41

CHAPTER THREE

RESEARCH DESIGN AND METHODOLOGY

3.1 An Overview - - - - - - - - - 42

3.2 Sources of Data - - - - - - - - 42

3.2.1 Primary Source- - - - - - - - 43

3.2.2 Secondary Source-- - - - - - - 43

3.3 population of the study-- - - - - - - 44

3.4 sample size and instrument used in determination

of the sample size - - - - - - - - - 45

3.6 Validity of the Instrument Used - - - - - 47

3.7 Reliability of the Study - - - - - - 47

CHAPTER FOUR

4.1 Summary of findings and discussion - - - - - 48

4.2 Discussions - - - - - - - - 49

CHAPTER FIVE

CONCLUSION AND RECOMMENDATION

5.1 Conclusion - - - - - - - - - 50

5.2 Recommendations - - - - - - - - 51

5.3 Suggestion for further research - - - - - 53

Bibliography - - - - - - - - - - 54

Appendix I - - - - - - - - - - 55

Appendix ii - - - - - - - - - - 56

CHAPTER ONE

INTRODUCTION

1.8 BACKGROUND OF THE STUDY

Health insurance is a social security system that guarantees the provision of needed health services to persons on the payment of taken contributions at regular intervals. The first attempt at adopting a health insurance system, Nigeria started in 1962 during the first republic. The federal government invited Dr. Halevi through the international labour organization (120) to look into starting a health insurance system in Lagos. Then minister for health Dr. Majekodunmi also presented the first bill to the parliament. When a committee was commissioned to study the national insurance (Oji, 2003). The health population and indeed work force are indisputable tools for rapid socio-economic and sustainable development the world over. Despite thus indisputable fact, in Nigeria like most Africa countries, the provision of quality accessible and affordable health care remark a serious problem (WHO, 2007, Oba, 2008), thus is because the health sector is permeably face with cross shortage of personnel, inadequate and outdated medical equipment policy inconsistence and corruption. Other factor that impede quality health care delivery IN Enugu include inability of the consume to pay for health services gender bias due to religious or cultural beliefs and inequality in the distribution of health care facilities between urban and rural areas. In 2007 for instance, world health organization (WHO) report on health care delivery ranked Nigeria 187 out of 191 countries than in 2005 only 48 and 35 percent of the children within the age of zero to one year old were fully immunized against tuberculosis and measles respectively between 1998 and 2005, 28 percent of the children with in the ages of 5 years who suffered from diarrhea received and equate treatment.

A social health insurance scheme involves contribution base on means and utilization based on need. A health insurance scheme has been define as an arrangement in which contribution are made by or behalf of employees or individual (members) to purchasing institution (a fund) which is responsible for purchasing coursed services from providers or behalf of the members of the scheme (Kutzin) 1997. It is the opinion of Nigeria government that the NHIS will probably provide effective health care services and help to improve accessibility to health care services and help to improve accessibility to health care services (Ibwaye 2007). But the assessment of the programme after four years of operation reveals less than 3% coverage (Ikpong: 2007), and these was as a result of poor implement of the scheme in Nigeria. This research will evaluate the effect of national health insurance in enhancing health care delivery in Enugu.

1.9 STATEMENT OF THE PROBLEM

The following are problems that prompted the research of this project work:

1. Failure to understand the significant contribution of effective and efficient national insurance scheme in Enugu.

2. Failure on the part of the Nigeria government to enhance easy accessibility of national health insurance scheme.

3. Poor effective administration and management of the activities and operation of the national health insurance scheme in Enugu.

4. Unawareness of the existence, roles, important benefits and workability of national health insurance scheme.

1.10 OBJECTIVE OF THE STUDY

The following are the objectives of the research work:

1. To find out the significant contributions of effective and efficient national insurance scheme in Nigeria.

2. To find out whether the government enhance easy accessibility of the national insurance in Enugu.

3. To examine whether there is any awareness of the existence, roles, important benefits and workability of the business activities of national insurance scheme in Enugu.

4. To find out the problems facing effective and efficient administration and management of national insurance scheme in Enugu.

1.11 RESEARCH QUESTIONS

The research question of thus research work include the following:

1. Is there any significant contribution of effective and efficient national health insurance in Enugu?

2. Are there any problem of effective and efficient administration and management of the national health insurance scheme in Nigeria?

3. Does Nigeria government enhancing easy accessibility to national health insurance role, important benefits and workability of the national health insurance scheme in Enugu?

4. Are there any impact of efficient national scheme in Enugu?

1.12 SIGNIFICANCE OF THE STUDY

This research work will be of immense significant to the following:

The study will educate the public or the existence, role, important benefits, workability, activities and business operation of national health insurance scheme in Enugu. The study will be useful for academic purpose and it will service as a data base for students and other academia carrying out further research in the related topic. The study will provide some useful information to the research and will give them the basis for validating or disapproving the findings of the research work. Thus research work will be of immense relevance to Enugu government in the sense that it would provide them with viable strategies and means of enhancing effective health delivery to rural dwellers.

1.13 SCOPE AND LIMITATION OF STUDY

SCOPE:

The scope of the research work is restricted to four (4) health management organization (united health care organization, total health care international health care and expect health care organization) and employees that have access to health care services.

The following are factors that limites the study of this research work:

1. Problem of obtaining all the necessary data or information from the respondent: the management officials of the selected health management organization (HMAS) felt so reluctant to release most of the information needed on the ground that the information are highly official and confidential .

2. Finance: the cost incurred in carrying out thus research is relatively high such expenses include: registration for research materials, transportation, internet browsing, privating and photocopying of relevant materials.

3. Time: The time allowed for this research work is too short that the researcher was not able to extend to all homes and all employees that have access to health care services in Nigeria.

4. Research work: there was dearth of previous work on the related topic of the study.

1.14 Definition of terms

- NHIS: National Health Insurance Scheme, it is a scheme that was established by Nigeria government to enhance effective and efficient health care delivery in Nigeria.

- Insurance: Insurance is a safeguard against risk it is a device aimed at reducing the chance of loss occurrence or when it occur, providing the affected person with compensation or benefits.

- Premium: It is the consideration paid by the insured to the insurance to enable the insured have a full insurance protection.

- Health insurance: Health insurance is an insurance policy that covers an individuals or individuals against cost or expenses on cost of accessing health care services.

- Ham: Health management organization that organizes effective and efficient delivery of health care services.

- Employers: This is a private or public or employers that pays 10% contributions for effective health care services for employees in their organization.

- Employee: Thus are people that pay 5% of their basic salary to benefit in the effective and efficient health care services.

- Contribution: It is an act of both the employer and employee contributing a certain percentage (%) of the basic salary for effective national insurance scheme.

- WHO: World Health Organization: Thus is the organization that report on health care delivery ranked in Nigeria in order to see effective changes in national health insurance.

- Socio-economic: Is the social science that studies how economic activity affects social process. In general it analyzes how societies progress, stagnate, or regress because of their or regional economic or the global economy.

- Population: all the inhabitants of a particular town, area, or country. A particular section, group or type of people or animals living in an area or country.

- Tuberculosis: Is an infectious disease that is caused by a bacterium called mycobacterium it can also affect organs in the central nervous system, lymphatic system and circulatory system among others.