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Effect of Health Insurance Education on Health Insurance Enrollment among Informal-Sector Workers in Nigeria

Abstract

Health insurance is an important mechanism for improving access to healthcare and reducing the financial burden associated with illness and healthcare utilization. However, enrollment in health insurance schemes among informal-sector workers in Nigeria remains a significant challenge because many workers operate outside formal employment arrangements and may have limited knowledge of available health insurance programmes, eligibility requirements, registration procedures, benefits, premium contributions, and claims processes. Health insurance education provides informal-sector workers with information about the purpose and benefits of health insurance, available insurance schemes, eligibility, enrollment procedures, premium payment requirements, covered healthcare services, claims processes, rights and responsibilities, and the financial protection provided by health insurance. Health insurance enrollment refers to the formal registration and active participation of eligible individuals in an approved health insurance scheme. In Nigeria, inadequate enrollment among informal-sector workers may be associated with limited awareness, misconceptions about insurance, affordability concerns, distrust of insurance providers, irregular income, perceived low need for insurance, and limited access to enrollment channels. Effective health insurance education may improve workers' understanding of health insurance and encourage enrollment in appropriate health insurance schemes. Against this background, this study investigates the effect of health insurance education on health insurance enrollment among informal-sector workers in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Theory of Planned Behavior. The Health Belief Model provides a framework for understanding workers' decisions to enroll in health insurance through perceived susceptibility to healthcare costs and illness, perceived severity of financial consequences, perceived benefits of insurance, perceived barriers, and cues to action. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, economic environment, and enrollment behaviour. The Theory of Planned Behavior explains how workers' attitudes toward health insurance, perceived social expectations, and perceived behavioural control may influence their intention and decision to enroll. Collectively, these theoretical perspectives provide a suitable framework for explaining how health insurance education may influence health insurance enrollment among informal-sector workers in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from informal-sector workers in selected Nigerian communities, markets, transport hubs, artisan clusters, small businesses, and other informal economic settings using a structured interviewer-administered questionnaire and health insurance enrollment assessment tool. A multistage sampling technique will be employed to select states, local government areas, communities, informal-sector clusters, and eligible workers. Where feasible, selected informal-sector worker groups or clusters will be assigned to intervention and comparison groups. Participants in the intervention group will receive structured health insurance education through group sessions, workplace or market-based sensitization, printed materials, audiovisual resources, and individual counselling. The education will cover the importance of health insurance, available health insurance schemes, eligibility requirements, enrollment procedures, premium contributions, benefit packages, healthcare-provider access, claims procedures, rights and responsibilities of enrollees, and financial protection against healthcare expenses. Health insurance enrollment will be assessed using indicators such as awareness of available schemes, registration status, active enrollment, possession of valid evidence of coverage, payment of required contributions where applicable, and intention to maintain enrollment. Where feasible, enrollment status will be verified through appropriate scheme records, subject to ethical and confidentiality requirements. Descriptive statistics will be used to summarize workers' sociodemographic and occupational characteristics, income patterns, previous exposure to insurance information, insurance knowledge, and enrollment status. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the effect of health insurance education on enrollment. Where appropriate, enrollment before and after the intervention will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that health insurance education has a significant positive effect on health insurance enrollment among informal-sector workers in Nigeria. Workers exposed to structured health insurance education are expected to demonstrate improved understanding of available insurance schemes, their benefits, eligibility requirements, registration procedures, and financial protection mechanisms. Education is expected to increase workers' willingness to register and participate actively in health insurance schemes and reduce misconceptions about insurance coverage and claims procedures. Education delivered through trusted community organizations, market associations, trade unions, cooperatives, community health workers, and other established informal-sector structures may be particularly effective in reaching workers who have limited access to formal health-information channels. However, education alone may not guarantee enrollment because informal-sector workers may continue to face barriers such as irregular income, affordability concerns, distrust of insurance institutions, limited accessibility of enrollment platforms, uncertainty about benefits, and previous negative experiences with healthcare or insurance services. Consequently, health insurance education may be most effective when supported by affordable contribution arrangements, accessible enrollment channels, transparent benefit packages, reliable healthcare services, efficient claims processes, and sustained public engagement. The study is expected to contribute to the literature on health insurance education, health insurance enrollment, informal-sector workers, health financing, social health protection, health education, healthcare access, and public health in Nigeria by providing empirical evidence on the effect of health insurance education on enrollment among workers in the informal sector. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Health Insurance Authority, state health insurance agencies, health insurance organizations, informal-sector associations, cooperatives, market associations, labour organizations, healthcare providers, public health practitioners, health educators, development partners, and policymakers regarding strategies for expanding health insurance coverage. The study will also provide evidence-based recommendations for strengthening health insurance education, simplifying enrollment procedures, expanding community and workplace-based registration channels, improving communication about insurance benefits, developing affordable contribution mechanisms for informal workers, strengthening public trust, and promoting sustainable health insurance enrollment among informal-sector workers in Nigeria.

Keywords: Health insurance education, health insurance enrollment, informal-sector workers, Nigeria, health insurance, social health protection, health financing, health education, healthcare access, insurance awareness, financial protection, informal economy, public health.