A comparative study of quality of care before and after introduction of National Health Insurance Scheme in health facilities in Zaria, Kaduna State, Northwestern Nigeria

Background: The National Health Insurance Scheme (NHIS) in Nigeria was introduced in 2005 to remove financial barriers to access of care and to improve quality of care. However, since introduction of the scheme, there has not been any documented study to assess whether there has any improvement in quality of care in the participating facilities as a result of its introduction. Objectives: This study was undertaken to determine and compare the quality of care before and after introduction of NHIS in health facilities in Zaria, Kaduna State, Northwestern Nigeria. Materials and Methods: The study was cross-sectional, descriptive, and comparative in design. Using stratified sampling one public and two private NHIS accredited secondary health facilities were selected. Adherence to Federal Ministry of Health performance standards for emergency obstetric care was used as proxy for quality. A retrospective analysis of a total of 320 case notes of female patients that were managed in these facilities for five maternal complications was undertaken, 160 before and 160 after introduction of NHIS. Results: Results showed that quality of care, represented by levels of adherence to standard treatment guidelines, was generally poor (42%). The mean adherence to standards of care levels at facility level of 37.9% before and 46.3% after introduction of NHIS was observed; this difference was statistically significant ( P = 0.005), with the public facility performing significantly better, with an adherence level of 59% compared to 30% for private facilities ( P = 0.001). Conclusion: The study demonstrated improvement in quality of care following introduction of NHIS in the facilities. Integrating supportive supervision and rapid expansion of the scheme are recommended to widely spread its quality-related benefits.