Exploring the Experiences of the National Health Insurance Scheme (NHIS) Policyholders on Maternal and Reproductive Health Services in Zambia

Background: An essential prerequisite for women's development is better maternal and reproductive health. Since 1991, Zambian governments have made tackling the nation's healthcare issues a top priority. Among the initiatives they have implemented, the National Health Insurance Scheme (NHIS) has been at the top of the list. The National Health Insurance Act No. 2 of 2018 resulted in the creation of the Scheme, which is overseen by the National Health Insurance Management Authority (NHIMA). This study intends to explore the perceptions and experiences of policyholders regarding the effectiveness and challenges surrounding the NHIS in improving maternal and reproductive health services in Zambia.  Methods: The study employed a phenomenological design using thematic analysis to explore the perceptions and experiences of policyholders regarding the effectiveness and challenges of NHIS in improving maternal and reproductive health services in Zambia. A purposive sample of 69 policyholders was selected for in-depth interviews. Data collection proceeded until saturation was reached, and all interviews were recorded, transcribed, and systematically coded. Thematic analysis was conducted to appreciate perceptions and challenges. Ethical approval and informed consent were obtained to ensure confidentiality and voluntary participation  Results: Thematic analysis revealed insights into the experiences and perceptions of NHIS policyholders. A significant number of policyholders reported positive experiences regarding increased access to maternal and reproductive health services since the implementation of the NHIS. The insurance scheme has made significant strides in reducing financial barriers, thus enabling more women to seek necessary medical care. However, despite the positive perceptions, the study identified several challenges that hinder the full potential of the NHIS. Key issues included limited coverage, particularly for rural populations, inadequate medical facilities, and a shortage of essential drugs and trained healthcare personnel. Such systemic problems have led to discrepancies in service delivery. While the NHIS has improved access, concerns regarding the quality of care persist. Some beneficiaries reported dissatisfaction with the services received, citing long wait times, lack of essential medical supplies, and inadequate infrastructure in health facilities. The quality of care directly impacts maternal and reproductive health outcomes, highlighting the need for ongoing investments in healthcare infrastructure and workforce training.  Limitations: A meta-analysis was not feasible due to the qualitative nature of the study, which limited the capacity to quantitatively synthesize the results.  Conclusions: As Zambia continues to work toward its health objectives, findings suggest that there are positive trends in enhancing access to these essential services. Increasing utilization of maternal health care facilities and improved health outcomes for mothers and newborns have been observed in some regions. However, despite these promising indications, numerous challenges persist that hinder the full realization of equitable and effective care for all women. By addressing these challenges, the NHIS can strengthen its impact and contribute to better health outcomes for mothers and their children in Zambia.