The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria

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dc.creatorNelissen, Heleen E.
dc.creatorBrals, Daniëlla
dc.creatorAmeen, Hafsat A.
dc.creatorvan der List, Marijn
dc.creatorKramer, Berber
dc.creatorAkande, Tanimola M.
dc.creatorJanssens, Wendy
dc.creatorvan’t Hoog, Anja H.
dc.date2020-03-01
dc.date2024-05-22T12:10:46Z
dc.date2024-05-22T12:10:46Z
dc.date.accessioned2026-06-27T14:55:36Z
dc.descriptionIn sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage.
dc.identifierhttps://hdl.handle.net/10568/142626
dc.identifier.urihttp://hdl.handle.net/123456789/89607
dc.languageen
dc.publisherOxford University Press
dc.relationhttps://doi.org/10.1016/j.worlddev.2018.07.004
dc.relationhttps://doi.org/10.1016/j.ijcard.2015.09.036
dc.relationhttps://doi.org/10.1093/wber/lhx001
dc.relationhttps://doi.org/10.2499/p15738coll2.133514
dc.rightsOpen Access
dc.sourceNelissen, Heleen E.; Brals, Daniëlla; Ameen, Hafsat A.; van der List, Marijn; Kramer, Berber; Akande, Tanimola M.; Janssens, Wendy; and van’t Hoog, Anja H. 2020. The prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria. Health Policy and Planning 35(3): 354–363. https://doi.org/10.1093/heapol/czz172
dc.subjectexpenditure
dc.subjecthealth insurance
dc.subjectdrugs
dc.subjecthealth
dc.subjectquality
dc.subjectrural areas
dc.subjecthealth care
dc.titleThe prominent role of informal medicine vendors despite health insurance: A weekly diaries study in rural Nigeria
dc.typeJournal Article

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Instituto Internacional de Investigación sobre Políticas Alimentarias (IFPRI)