Assessment of the Role of Health Insurance Schemes in Improving Access to Healthcare in Markets within Adamawa State (A Case Study of Traders in Jimeta Market)

Abstract

Despite the transition from the voluntary National Health Insurance Scheme (NHIS) to the mandatory National Health Insurance Authority (NHIA) Act of 2022, the informal sector in Nigeria, comprising over 80% of the workforce, remains largely uninsured. In Adamawa State, the Adamawa State Contributory Health Management Agency (ASCHMA) was established to achieve Universal Health Coverage (UHC), yet the transition of market traders from out-of-pocket payers to insured beneficiaries remains a significant challenge. This study assessed the role of health insurance in improving healthcare access among traders in the Jimeta Ultra-Modern Market, Adamawa State, focusing on awareness, enrollment barriers, and the impact of urban renewal activities. A descriptive cross-sectional research design was employed. Using the Taro Yamane formula, a sample of 370 traders was targeted, with 350 valid responses obtained. A multi-stage sampling technique was used to select participants from various market zones. Data were collected via a structured 22-item questionnaire and analyzed using SPSS version 25.0, utilizing both descriptive and inferential statistics. The study reveals a significant "awareness-enrollment gap." While 81.4% of traders are aware of ASCHMA, only 5.3% are actually enrolled in the informal sector health plan. Out-of-pocket (OOP) spending remains the dominant payment mode for 88.7% of respondents, with mean costs per illness episode ranging from N3,820 to N7,863. Financial constraints (85.9%) and a lack of institutional trust (58.3%) are the primary barriers to uptake. Furthermore, the 2024 Jimeta market demolition exercise exacerbated health vulnerabilities, with 74.3% of traders reporting increased medical expenses due to demolition-related environmental hazards. The role of health insurance in improving access for Jimeta traders is currently more theoretical than actualized. Liquidity constraints and systemic disruptions like urban renewal further hinder enrollment. It is recommended that ASCHMA implements a "micro-premium" installment model (e.g., N250 daily) through market unions and integrates social health protection clauses into urban development policies to mitigate "planning blight".