Healthcare financing in Nigeria: A systematic review assessing the evidence of the impact of health insurance on primary health care delivery

Strengthening health systems, improving health outcomes, as well as finding answers to the competing alternatives of healthcare financing are critical issues that continue to bother health policy makers. Irrespective of the options, the choice of health care financing should mobilize resources for health and improve access to quality care at the same time. Notably, the health financing policy in Nigeria provides a framework for establishing health insurance schemes so as to expand coverage in health care delivery for the formal and informal sectors as a strategy towards universal access to healthcare. Accordingly, the authors, through this review, systematically assess the evidence of the extent to which health insurance impacts on access to services and quality of primary healthcare in Nigeria. While this comes to bear, the findings reveal an evidence of moderate-to-high strength that health insurance increases access to care and improves the quality of care received; however, it remains equivocal in some instances. The review therefore contributes to the literature on healthcare financing by extending and qualifying existing knowledge and advocating for accelerated reforms if universal coverage will be achieved.