Open Access Open Badges Research article

Assessing responsiveness of health care services within a health insurance scheme in Nigeria: users’ perspectives

Shafiu Mohammed14, Justo Lorenzo Bermejo2, Aurélia Souares1, Rainer Sauerborn1 and Hengjin Dong13*

Author Affiliations

1 Institute of Public Health, Medical Faculty, Heidelberg University, Heidelberg, Germany

2 Institute of Medical Biometry and Informatics (IMBI), University Hospital Heidelberg, Heidelberg, Germany

3 Center for Health Policy Studies, Zhejiang University Medical School, Zhejiang, China

4 Ahmadu Bello University, Zaria, Nigeria

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BMC Health Services Research 2013, 13:502  doi:10.1186/1472-6963-13-502

Published: 1 December 2013



Responsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users’ perspectives of their health care services’ responsiveness.


This retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users’ perspectives on responsiveness to health services and quantify their effects.


Communication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as “extremely important” responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains.


Assessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme’s implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve this responsiveness. For the Nigerian context, we suggest that health care providers in the NHIS should pay attention to these domains, and the associated characteristics of users, when delivering health care services to their clients. Policy makers, and the insurance regulatory agency, should consider the reform strategies of monitoring and quality assurance which focus on the domains of responsiveness to lessen the gap between users’ expectations and their experiences with health services.

Health insurance; Users; Health care services; Responsiveness; Nigeria; Performance