Enrollees’ Satisfaction with Health Service Delivery Under the Katsina State Contributory Health Scheme, Nigeria: Findings from a 2025 Cross-Sectional Survey

Nasiru Lawal^1,3*, Hassan Abdulsamad¹, Mukhtar Bature¹, Hassan Abdulsamad¹, Abdullahi Isah¹, Usman Haruna¹, Shamsudeen Yahaya²

¹Katsina State Contributory Healthcare Management Agency, Nigeria.

²Katsina State Primary Healthcare Agency, Nigeria.

³Department of Community Medicine, Umaru Musa Yar’adua University Katsina.

*Correspondence: Nasiru Lawal, Katsina State Contributory Healthcare Management Agency, Department of Community Medicine, Umaru Musa Yar’adua University Katsina, Nigeria, E-mail: formular32@yahoo.co.uk

Received date: 02 Apr, 2026; Accepted date: 24 Apr, 2026; Published date: 30 April, 2026

Citation: Nasiru Lawal. “Enrollees’ Satisfaction with Health Service Delivery Under the Katsina State Contributory Health Scheme, Nigeria: Findings from a 2025 Cross-Sectional Survey.” J Healthc Adv Nur (2026): 137. DOI: 10.59462/3068-1758.4.1.137

Copyright: © 2026 Nasiru Lawal. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Abstract

Background: Client satisfaction is an important indicator of health system performance and sustainability of insurance programmes. This study assessed enrollee satisfaction with services provided under the Katsina State Contributory Healthcare Management Agency (KTSCHMA).

Methods: A cross-sectional survey was conducted among 1,379 enrollees (697 Formal Sector; 682 BHCPF). Data were collected using a structured SERVQUAL-based questionnaire and analysed using descriptive and inferential statistics.

Results: Overall satisfaction was moderate (50–54%). Highest ratings were observed in assurance and empathy, reflecting positive perceptions of staff courtesy, competence, and respectful care. Lowest ratings were reported in responsiveness and reliability, particularly waiting time, medicine availability, appointment delays, and limited 24-hour services. Knowledge of benefits and procedures was low, especially among BHCPF beneficiaries.

Conclusion: KTSCHMA has established a credible platform for healthcare access and financial protection. However, improvements in service efficiency, communication, enrollee education, and medicine supply systems are required

Introduction

State health insurance schemes are central to achieving Universal Health Coverage (UHC) in Nigeria. KTSCHMA was established under Katsina State Law No. 10 of 2018 to improve financial protection and equitable access to healthcare. Although enrolment has expanded substantially, evidence on user satisfaction remains limited. Satisfaction influences utilization, retention, trust, and willingness to recommend the scheme. This study assessed enrollee satisfaction, knowledge, and service experiences under the Formal Sector and Basic Health Care Provision Fund (BHCPF) programmes.

Methods

A facility-based cross-sectional descriptive study was conducted in 2025. Respondents were selected using proportionate allocation and systematic random sampling across participating facilities. A structured interviewer-administered questionnaire assessed socio-demographic variables, knowledge of scheme benefits, referral experiences, administrative services, and SERVQUAL domains: tangibles, reliability, responsiveness, assurance, and empathy.

Data were analysed using SPSS version 25. Frequencies, percentages, means, chi-square tests, t-tests, and ANOVA were used. Statistical significance was set at p<0.05.

Results

Table 1: Socio-Demographic Characteristics of Enrollees

The respondents were predominantly within the productive age group of 26–35 years (50%), followed by those aged 36–45 years (25%), indicating a largely young and middle-aged population. Males constituted the majority of respondents (70%), while females accounted for 30%.

In terms of educational attainment, more than half of the respondents (55%) possessed a Diploma or Degree, with 10% holding a Master’s degree, reflecting a relatively educated population. All respondents (100%) were employed full-time, suggesting financial engagement and job stability.

Regarding income, the largest proportion earned between ₦51,000–₦100,000 (35%), while 30% earned below ₦30,000, indicating a mixed income distribution. Concerning enrollment duration, most respondents had been enrolled for 1–2 years (40%) or 3–5 years (30%), demonstrating moderate to long-term participation in the program.

Table 2: Detailed Breakdown by Dimension

The SERVQUAL analysis revealed varying levels of enrollee satisfaction across the five dimensions of service quality.

Under the tangibles dimension, findings showed a generally high level of satisfaction among respondents. Cleanliness and hygiene of healthcare facilities were positively rated, with the majority of enrollees reporting being either very satisfied or satisfied. Similar positive perceptions were recorded for the availability of modern medical equipment, staff uniforms, comfort of facilities, and clarity of signage. Dissatisfaction levels across these indicators were minimal, indicating that the physical environment and appearance of service delivery points were largely acceptable to enrollees.

Regarding reliability, respondents expressed moderate to high satisfaction with the accuracy of diagnosis, consistency in the quality of care, and fulfillment of appointments. However, comparatively lower satisfaction was observed in the availability of drugs and prescribed medicines, where a notable proportion of enrollees reported dissatisfaction. This suggested that while clinical competence and continuity of care were perceived as reliable, medicine availability remained a challenge in some facilities.

The responsiveness dimension recorded the lowest satisfaction scores among all SERVQUAL components. Waiting time to see a doctor, emergency response, ease of getting appointments, speed of service delivery, and availability of 24-hour services attracted higher levels of neutral and dissatisfied responses. In particular, 24-hour service availability and appointment scheduling recorded substantial dissatisfaction, indicating delays and limited access to timely care as key concerns for enrollees.

In contrast, the assurance dimension demonstrated very strong performance. A large majority of respondents reported being very satisfied or satisfied with staff courtesy, competence, confidentiality of medical records, confidence in healthcare providers, and clarity of explanations regarding care received. Reports of dissatisfaction in this domain were negligible, reflecting high trust and professionalism among healthcare workers.

Similarly, findings under the empathy dimension showed consistently high satisfaction levels. Enrollees positively rated healthcare staff on listening to complaints, showing respect and dignity, providing special attention, understanding patient needs, and offering emotional support. Very few respondents expressed dissatisfaction, suggesting that interpersonal aspects of care and patient-centeredness were strong features of service delivery under the scheme.

Overall, the SERVQUAL findings indicated strong performance in tangibles, assurance, and empathy, moderate performance in reliability, and relatively weak performance in responsiveness, highlighting critical areas for quality improvement interventions.

Table 3: Knowledge Assessment of formal sector beneficiaries

The knowledge assessment of respondents under the Formal Sector Program indicates a generally low level of awareness of scheme benefits and operational guidelines. With an average knowledge score of 26.3%, a median of 20%, and a mode of 10%, the results show that most beneficiaries possess only limited understanding of the program. Very few respondents (0.3%) demonstrated complete knowledge, while a notable proportion (7.6%) had no correct answers at all, reflecting widespread information gaps among enrollees.

Item-level analysis reveals uneven knowledge across program components. Respondents showed strong understanding of medicine co-payment requirements (81.5%), PHC selection procedures, and benefit waiting periods. However, substantial gaps were observed in critical areas such as emergency care access, family composition coverage, addition of extra dependents, and PHC change timelines. These findings highlight the need for improved beneficiary sensitization, simplified communication materials, and continuous education to enhance understanding and effective utilization of the Formal Sector Program.

Table 4: Findings on Referral Process Among Enrollees

The findings on the referral process indicated an overall positive experience among most enrollees who had a history of referral under the scheme. A large proportion of respondents reported that obtaining a referral from their primary healthcare facility was easy, with more than half indicating that referral documentation was completed on the same day. Satisfaction with the attitude and care provided by healthcare staff during the referral process was high, and most enrollees were attended to promptly upon arrival at the referral (secondary) facility. The quality of care received at referral facilities was also rated as good or very good by the majority of respondents.

Despite these positive outcomes, some challenges were identified. Communication of the referral process was often incomplete, as many respondents reported that explanations provided by health workers were only partial or unclear. Additionally, issues related to responsiveness, such as waiting times, occasional demands for unofficial payments, and limited availability of 24-hour services, were reported by a subset of enrollees. Utilization of the KTSCHMA helpline during referral was low, although those who accessed it reported varying levels of support. Overall, while the referral system under the scheme functioned satisfactorily for most enrollees, the findings highlighted the need for improved communication, strengthened accountability, and enhanced responsiveness to further improve referral service delivery.

Table 5: Registration Update and ID Card Possession Among Enrollees

The findings showed that ID card possession among enrollees was high, with most respondents reporting that they had received their KTSCHMA identification cards, mainly from the Agency office or health facilities. However, only a small proportion of enrollees had ever updated their registration details. Among those who had updated their information, the update points were generally easy to locate, and staff conduct during the process was rated positively.

Despite these strengths, delays were reported in initiating updates, with many respondents indicating long waiting periods before the process commenced. Although the update procedures were clearly explained to most enrollees and satisfaction with the speed and quality of services was high, a notable minority reported experiencing challenges, including requests for unofficial payments. Overall satisfaction with update services remained high, and most respondents expressed willingness to continue their enrolment with the KTSCHMA.

Full Analytical Report: BHCPF Program KTSCHMA Client Satisfaction Survey (2025)

Table 6: Sociodemographic Characteristics (n=682)

The socio-demographic characteristics of respondents showed a diverse distribution across age, gender, education, employment status, and income levels. The largest proportion of respondents fell within the 26–35-year age group, followed by those aged 36–45 years and 56–65 years. Younger respondents aged 18–25 years also constituted a substantial share, while fewer respondents were within the 46–55-year age group and those above 65 years.

In terms of gender, females constituted the majority of respondents, accounting for nearly three-fifths of the study population, while males made up just over two-fifths. Regarding educational attainment, a significant proportion of respondents had Qur’anic education or secondary school education. Smaller proportions reported having a university degree or primary school education, while less than one-tenth of respondents had no formal education.

The employment profile revealed that most respondents were self-employed, reflecting the dominance of informal sector participants within the scheme. Retirees and students constituted relatively small proportions of the study population. With respect to income, the majority of respondents earned below ₦30,000 per month, while smaller proportions reported monthly earnings between ₦31,000 and ₦50,000, and ₦51,000 to ₦100,000. Only a small fraction of respondents reported monthly incomes above ₦101,000, indicating that most enrollees belonged to low-income households.

Overall satisfaction with KTSCHMA services was moderate. Formal Sector respondents generally reported better experiences than BHCPF respondents.

Across both groups, assurance and empathy recorded the highest satisfaction scores. Respondents expressed confidence in staff competence, courtesy, confidentiality, and respectful treatment.

The weakest domains were responsiveness and reliability. Major concerns included long waiting times, delays in appointments, poor emergency responsiveness, inconsistent availability of medicines, and limited 24-hour services. These concerns were more pronounced among BHCPF beneficiaries.

Knowledge of scheme rules and benefits was suboptimal. Significant gaps were observed regarding waiting periods, dependent coverage, emergency access, and referral pathways.

Referral services were generally functional, although incomplete explanations and occasional unofficial payment requests were reported. ID card possession exceeded 92%, but registration update delays remained common.

Discussion

This study found moderate overall satisfaction among KTSCHMA enrollees. High ratings for assurance and empathy indicate that beneficiaries’ value positive provider–patient interactions. Similar findings were reported in Anambra State, where assurance and empathy were major predictors of enrollee satisfaction [1]. These findings also align with the SERVQUAL framework, which emphasizes assurance and empathy as critical determinants of perceived service quality and patient satisfaction [2].

Long waiting times and medicine shortages identified in this study are consistent with reports from Ebonyi State and other Nigerian insurance settings, where delays and stock-outs reduced user satisfaction [3,4].

The poorer ratings among BHCPF respondents may reflect infrastructure and staffing constraints within primary healthcare facilities. National evidence on BHCPF implementation has shown variability in facility readiness and governance capacity across states [5].

Low beneficiary knowledge found in this study is particularly important because awareness influences utilization, adherence to referral pathways, and confidence in programme operations [6]. Continuous beneficiary education is therefore essential.

Overall, the findings suggest that KTSCHMA has built a credible platform for expanding healthcare access in Katsina State. However, sustained gains will depend on reducing waiting times, strengthening medicine supply systems, improving communication, and enhancing administrative efficiency.

Conclusion

KTSCHMA beneficiaries reported moderate satisfaction with services, especially staff professionalism and respectful care. However, long waiting times, medicine shortages, administrative delays, and low beneficiary knowledge reduced programme performance. Addressing these gaps will improve enrollee experience and strengthen progress toward Universal Health Coverage in Katsina State.

Recommendations

1. Strengthen beneficiary education using simple local-language materials.

2. Reduce waiting times through workflow redesign and appointment systems.

3. Improve medicine supply chain management across accredited facilities.

4. Digitize registration updates and complaints management.

5. Upgrade facility signage and essential equipment.

6. Train providers on communication and patient rights.

7. Strengthen accountability systems to prevent unofficial payments.

References

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2. Parasuraman, Arun, Leonard L. Berry, and Valarie A. Zeithaml. "Refinement and reassessment of the SERVQUAL scale." Journal of retailing 67, no. 4 (1991): 420.

3. Okah, Paulinus Sunday. "Narratives of Satisfaction and Dissatisfaction with Nigeria’s National Health Insurance Scheme: A Qualitative Study of Federal Enrollees in Ebonyi State." Global Social Welfare (2025): 1-16.

4. Nwanaji-Enwerem, Onyemaechi, Paul Bain, Zoe Marks, Pamaji Nwanaji-Enwerem, Catherine A. Staton, Ayobami Olufadeji, and Jamaji C. Nwanaji-Enwerem. "Patient satisfaction with the Nigerian National Health Insurance Scheme two decades since establishment: A systematic review and recommendations for improvement." African journal of primary health care & family medicine 14, no. 1 (2022): 3003.

5. Igbokwe, Uchenna, Raihanah Ibrahim, Muyi Aina, Musa Umar, Muhammed Salihu, Efosa Omoregie, Firdausi Umar Sadiq et al. "Evaluating the implementation of the National primary health care development agency (NPHCDA) gateway for the basic healthcare provision fund (BHCPF) across six Northern States in Nigeria." BMC Health Services Research 24, no. 1 (2024): 1404.

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