Barriers to enrollment in National Health Insurance Scheme among informal sector workers in Nigeria.

Extending health insurance coverage to informal sector populations remains a major challenge toward achieving universal health coverage. This study aimed to fill the gap in the literature by examining barriers to enrollment in National Health Insurance Scheme (NHIS) among informal sector workers in Nigeria. Data were drawn from the 2018 Nigeria Demographic and Health Survey. The study population comprised of men (n = 10,163) and women (n = 22,216) working in the informal sector. Bivariate and multivariate logistic regression were used to examine barriers to enrollment in NHIS. Results show that the majority of men (98.9%) and women (98.6%) were not enrolled in NHIS. Age, gender of household head, educational level, socioeconomic status, geopolitical zone, distance to a health facility, frequency of reading newspapers or magazines, and watching television were significantly associated with non‐enrollment in NHIS. Findings suggest that enrollment in NHIS in Nigeria is very low. Additionally, there are significant barriers to enrollment. There is a need for governments and policymakers to address these barriers. The use of voluntary prepayments from informal sector workers as a strategy to extend health insurance coverage has not been effective. Key Points: This study examined barriers to enrollment in National Health Insurance Scheme (NHIS) among informal sector workers in Nigeria.Findings indicate that the majority of men (98.9%) and women (98.6%) were not enrolled in NHIS.Authors also found that age, gender of household head, educational level, socioeconomic status, geopolitical zone, distance to a health facility, frequency of reading newspapers or magazines, and watching television were significantly associated with non‐enrollment in NHIS.The use of voluntary prepayments from informal sector workers as a strategy to extend health insurance coverage has not been effective. [ABSTRACT FROM AUTHOR]