KNOWLEDGE, ATTITUDE AND UTILIZATION OF TERTIARY INSTITUTIONS' SOCIAL HEALTH INSURANCE PROGRAM AMONG UNDERGRADUATES AT THE UNIVERSITY OF BENIN
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Background: The Tertiary Institutions Social Health Insurance Programme (TISHIP) was designed to provide qualitative healthcare and financial risk protection for students in Nigerian tertiary institutions. Despite its potential to ensure Universal Health overage (UHC), limited awareness and low utilisation remain significant challenges that hinder its effectiveness in addressing the health needs of the undergraduate population. Aim: This study assessed the knowledge, attitude, and utilisation of the Tertiary nstitutions Social Health Insurance Programme (TISHIP) among undergraduate students at the University of Benin, Edo State. Methods: A descriptive cross-sectional study was conducted among 646 undergraduate students selected using a multistage sampling technique. Data were collected using a pretested, structured, self-administered questionnaire covering socio-demographic characteristics, knowledge, attitude, utilisation, and barriers to the use of TISHIP. Data were analysed using SPSS version 27.0.
Univariate analysis summarised means, frequencies, and percentages. Bivariate analysis using chisquare tests determined associations between socio-demographic factors and respondents’ knowledge and utilisation. Binary logistic regression identified independent determinants of good utilisation. Statistical significance was set at p<0.05. Results: A total of 646 respondents participated, with a mean age of 20.3 ± 2.5 years. Three hundred and seventy-five (58.0%) were male, while 271 (42.0%) were female. Overall, knowledge was low, as only 26 (4.0%) had good knowledge of the scheme, while 620 (96.0%) had poor knowledge. espondents aged ˃ 20 years (6.1%) demonstrated a significantly higher proportion of good knowledge compared to those ≤ 20 years (2.6%) (p = 0.025). Regarding attitude, 133 (60.5%) demonstrated a positive attitude towards TISHIP, while 87 (39.5%) demonstrated a negative attitude. Two hundred and seventy-three (42.3%) of the respondents were enrolled in the scheme. Utilisation was poor, as only 102 (37.4%) of enrolled students had ever utilised the services. Respondents in higher academic levels (400L–600L) had a significantly higher proportion of utilisation (57.1%) compared to those in lower levels (24.0%) (p < 0.001).
Multivariate analysis showed that academic level was a significant determinant, with students in lower levels being less likely to utilise the scheme compared to their seniors (OR = 0.360, 95% CI = 0.161–0.806, p = 0.013). Conclusion: Undergraduates at the University of Benin demonstrated a generally negative attitude toward TISHIP, coupled with abysmally low knowledge and poor utilisation practices. Significant gaps in institutional communication and administrative barriers remain. Targeted health education
during orientation and the digitalisation of registration processes are essential to improve awareness and ensure effective utilisation of the health insurance scheme.
Univariate analysis summarised means, frequencies, and percentages. Bivariate analysis using chisquare tests determined associations between socio-demographic factors and respondents’ knowledge and utilisation. Binary logistic regression identified independent determinants of good utilisation. Statistical significance was set at p<0.05. Results: A total of 646 respondents participated, with a mean age of 20.3 ± 2.5 years. Three hundred and seventy-five (58.0%) were male, while 271 (42.0%) were female. Overall, knowledge was low, as only 26 (4.0%) had good knowledge of the scheme, while 620 (96.0%) had poor knowledge. espondents aged ˃ 20 years (6.1%) demonstrated a significantly higher proportion of good knowledge compared to those ≤ 20 years (2.6%) (p = 0.025). Regarding attitude, 133 (60.5%) demonstrated a positive attitude towards TISHIP, while 87 (39.5%) demonstrated a negative attitude. Two hundred and seventy-three (42.3%) of the respondents were enrolled in the scheme. Utilisation was poor, as only 102 (37.4%) of enrolled students had ever utilised the services. Respondents in higher academic levels (400L–600L) had a significantly higher proportion of utilisation (57.1%) compared to those in lower levels (24.0%) (p < 0.001).
Multivariate analysis showed that academic level was a significant determinant, with students in lower levels being less likely to utilise the scheme compared to their seniors (OR = 0.360, 95% CI = 0.161–0.806, p = 0.013). Conclusion: Undergraduates at the University of Benin demonstrated a generally negative attitude toward TISHIP, coupled with abysmally low knowledge and poor utilisation practices. Significant gaps in institutional communication and administrative barriers remain. Targeted health education
during orientation and the digitalisation of registration processes are essential to improve awareness and ensure effective utilisation of the health insurance scheme.
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