International Journal of Humanities and Social Science Research 43 International Journal of Humanities and Social Science Research ISSN: 2455-2070; Impact Factor: RJIF 5.22 www.socialresearchjournals.com Volume 2; Issue 8; August 2016; Page No. 43-48 Understanding the challenges and prospects of administering the national health insurance scheme in Nigeria Felix Onen Eteng, Uno Ijim-Agbor Ph.D, Department of Public Administration, University of Calabar, Calabar, Nigeria Abstract Providing healthcare services to public service workers in Nigeria has not been an easy task. With fixed and low income, majority of the public service workers cannot boast of meeting their basic medical needs. They are daily confronted with the condition of high cost of drugs and medical services which are not easily affordable. Besides, there is the general lamentation on the inability of public servants to access adequate and effective healthcare arising mainly from poverty occasioned by meager monthly emolument, the dearth of trained medical personnel, infrastructural decay, and poor funding of the medical system. This appalling condition prompted the federal government in Nigeria to introduce the National Health Insurance Scheme (NHIS) in order to address this situation. Unfortunately, NHIS seems unable to provide the expected healthcare services due to a number of challenges. This paper identified these challenges ranging from poor public conception of the scheme, corruption, cultural dementia to excessive bureaucratization among others. As a pathway to its success, the paper suggests among others an act for a special trust fund and mandatory participation. Keywords: Public service workers, Administration, National Health Insurance Scheme, Challenges Introduction The public service is one of the colonial legacies bequeathed to Nigeria by the British. The 1999 Constitution in Nigeria describes the public service as the “service of the federal, states, and local governments”. Public service consists of the following core services: (i) civil service, (ii) National and State Assemblies (iii) the Judiciary (iv) Armed Forces (v) the Police and other Allied or Security Services (vi) Paramilitary services like the Customs, Prisons, and Immigration (vii) Parastatals like Educational Institutions, Research Institutions and Regulatory Agencies, etc. It is a formal sector that is assigned the responsibility of carrying out the business of government. This business involves the implementation of government programmes and policies. Those who carry out the responsibility of the government in the public service are described as public service workers, and are often classified as staff. They occupy career positions of responsibility, and are entitled to official benefits which if not guaranteed can affect productivity and output. One of these benefits is the healthcare services that are expected to be utilized at inexpensive cost. Regrettably, these expectations of the workers have changed over time. The public service workers are continually faced with the challenges of high cost of medical bills and services, shortage of qualified medical personnel, decaying standard of infrastructure, and shortage of funds. This unpleasant situation confronting the workers prompted the government to establish the National Health Insurance Scheme (NHIS) with the aim to achieve the following objectives:  To ensure a fair distribution of healthcare services among workers in Nigeria  To ensure that healthcare services are provided at reduced cost to workers.  To increase the confidence and morals of the private sector in order to promote effective participation in healthcare delivery service.  To ensure excellent standards and requirements for the healthcare services in Nigeria.  To boost primary, secondary, and tertiary healthcare in Nigeria.  To create awareness and voluntarily mobilize workers for healthcare services  To promote health education among workers in Nigeria. These laudable objectives of the scheme were not however, implemented as expected due to some challenges. Indeed, since its establishment, many low income workers seem not able to benefit from the scheme perhaps because of increase in the cost of healthcare services. This situation could explain why many still patronize Traditional Medical Practice which is extremely cheap and easily affordable. Therefore, in view of government intention to handle the healthcare needs of the public service workers in the country, it introduced a health insurance scheme which seems wobbling and uncertain. This study examines the possible challenges facing the survival of the scheme and suggests the way forward. Data from the study were mainly secondary and were qualitatively discussed. Conceptual clarification The National Health Insurance Scheme (NHIS) is a formal sector social health insurance programme introduced by the federal government in Nigeria. NHIS Operational Guidelines (2005) described the scheme as “a social health security system in which the healthcare of employees in the formal sector is paid for from funds created by pooling the contributions of employees and employers”. Membership of the scheme is at present voluntary, and covers enrollees from the following formal sectors: (i) public sector, (ii) Armed Forces (iii) Organized Private Sector (iv) Voluntary