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In this study we explored perspectives on treatment adherence among patients who received hypertension care in the context of a community based health insurance program in rural Nigeria.
As a first stage of a larger project [ 39], we conducted a qualitative study among hypertensive patients who participated in the community based health insurance program in Kwara state to explore their views on hypertension management.
For example, within the context of a community based health insurance program, it would also be relevant to further investigate views on treatment adherence among patients who dropped out of treatment, despite the fact that they had access to good care.
The present study was conducted in the context a subsidized community based health insurance program that covers the costs of primary and limited secondary health care and medications, for low income residents of rural communities in Kwara state, the 9th poorest among Nigeria's 36 states.
To provide information for adherence support interventions, this study explored what low income patients who received hypertension care in the context of a community based health insurance program in Nigeria perceive as inhibitors and facilitators for adhering to pharmacotherapy and healthy behaviors.
The framework of inhibitors and facilitators to adherence that emerged from this study (see Figure 1) suggests that, in the case of the community based health insurance program in Kwara state, a number of additional interventions may be needed to remove barriers that patients face in adhering to their treatment.
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Despite 'affordability of care' – a feature of community based health insurance programs and insured care in general, hypertensive patients in SSA settings may still face other challenges in adhering effectively to prescribed treatment.
By 2009, the Rwandan government had improved access to primary health services mainly through infrastructure development and expansion of a community-based health insurance program.
In this paper, we describe the design of a study that has the aim to develop and test a program for cardiovascular health education for patients who are enrolled in a subsidized, community-based health insurance program in Nigeria and are at an increased risk of developing CVD.
Prepayment arrangements in the form of voluntary community based health insurance schemes and private health insurance are generally insignificant [ 12].
Different insurance mechanisms have been designed recently to protect the poor against excessive health expenditure, including community based health insurance [ 18, 19], national health insurance [ 19– 23], and health insurance for the poorest groups of populations [ 7].
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