Appraising construction artisans health insurance enrolment to achieve sustainable development goal 3 in the informal sector: issues and solutions Open Access

The construction industry comprises many stakeholders, including artisans in the informal sector. In developing countries, including Nigeria, informal construction artisans are vital to economic growth and are majorly involved in labour-intensive activities (Sanchez et al., 2017). The industry generates employment prospects for the young adult unemployed (Ebekozien et al., 2018). The industry faces hazards and remains a threat to decent work that can enhance economic growth. It corroborated Ogundipe et al. (2018) and Ebekozien (2021), who found high-hazard occurrences in developing countries’ industries and suggested ways to enhance occupational safety practices. The construction sector is ranked top among risky industries (Sanchez et al., 2017). This claim supported Park et al. (2015), who affirmed that the sector is hazardous. The informal sector artisans may be the worst hit. Despite the benefits of the industry to the stakeholders, including young adults and society, the financial risk of ill health may be challenging and impact their economic well-being negatively. Governments encourage enrolment into micro health insurance schemes to sustain artisans’ well-being and achieve universal health coverage.

Mahmood et al. (2018) described micro health insurance as a customised scheme. It is used in many developing countries to protect low-income citizens and those in the informal sector against financial risk during and after active service. Donfouet and Mahieu (2012) and Mahmood et al. (2018) identified the potential of micro health insurance in offering financial protection to low-income countries, including Nigeria. The financing mechanism that enhances the protection also highlights the role of community and micro health insurance. Micro health insurance can integrate clients from the informal sector to sustain their well-being and achieve universal health coverage for the construction artisans in the informal sector because of their role in economic growth. This is to mitigate challenges facing the informal construction artisans in developing countries. In India, micro health insurance is an innovative health financing scheme that manages the insurance needs of low-income earners (Savitha, 2012). It assists in mitigating extreme poverty that would have resulted from huge medical bills. Savitha (2012) examined the awareness and features of the Sampoorna Suraksha Programme, a micro insurance programme established by the Sri Kshetra Dharmasthala Rural Development Project in Karnataka, India. In Bangladesh, Mahmood et al. (2018) emphasised that micro health insurance can enhance health-financing for universal coverage, including low-income earners, if well implemented. Financial sustainability may be a challenge.

Awosusi (2022) opined in Nigeria that the signed National Health Insurance Authority Bill empowered effective regulators and made health insurance mandatory for all citizens and legal residents. Shehu (2022) asserted that the signed bill creates a framework to finance health service delivery for low-income and disadvantaged earners. The Act 2022 also repeals the National Health Insurance Scheme Act 2004, effective 19th May 2022. The challenge is the lax implementation to the disadvantage of the poor and vulnerable. Awosusi (2022) emphasised that the 2014 National Health Authority provides a mechanism to mobilise resources from several sources to finance access and affordable primary healthcare. This includes philanthropic, private, public and ancillary sources (Abubakar et al., 2022). The collaboration between the National Primary Health Care Development Agency and state governments has yielded positive progress in many primary healthcare development agencies. Hanson et al. (2022) reported that in Nigeria’s Demographic and Health Survey, 3% of people have health insurance coverage. Barriers such as cultural, socioeconomic and political factors hindered the uptake of health insurance (National Population Commission, 2018). This may threaten to improve achieving sustainable development goal 3 (good health and well-being). Goal 3 is one of the 17 United Nations sustainable development goals expected to be achieved on or before 2023 by UN members (Ebekozien et al., 2024a).

A few studies (Peterson et al., 2018; Gustafsson-Wright et al., 2018; Aregbeshola and Khan, 2018; Umeh, 2018; Awosusi, 2022) focused on micro health insurance schemes in the formal or informal sector, but none regarding how to improve micro health insurance policy enrolment for construction artisans in the informal sector and, by extension, improve the achievement of Goal 3. Peterson et al. (2018) discovered declining enrolment in the informal sector in the private micro health insurance scheme. It also found that the main barriers were inadequate client education, lax use of the health insurance plan, misaligned incentives and changes to the compulsory enrolment requirements. Gustafsson-Wright et al. (2018) examined the impact of subsidised private health insurance schemes in rural locations and how they have enhanced the economic growth of the citizens. It was discovered that rural people’s healthcare spending reduced drastically after the programme intervention through increased healthcare use in treatment areas among the insured. Umeh (2018) found that a segmented health insurance fund pool, a poorly funded primary healthcare system, and a large informal sector with mostly uninsured members are the barriers facing universal health coverage. One of the root causes (large informal sector whose members are mostly uninsured) is the study’s motivation, focusing on construction artisans because of the significance of the relationship between healthy lives and productivity.

Besides the paucity of literature regarding the enrolment of construction artisans in micro health insurance schemes in developing countries’ informal sectors, including Nigeria, it is pertinent to continuously research ways to improve micro health insurance policy enrolment for construction artisans in the informal sector, particularly in countries with lax rules and regulations regarding informal construction artisans’ engagement. Investigating the cause of construction artisans’ low enrolment will help proffering measures to achieve Goal 3. This is crucial due to the role of the informal sector in advancing economic growth through good health and well-being. It is impossible to accomplish SDG 3 without accessible and affordable health in the informal sector. Hence, construction artisans in the informal sector are key to the 2030 Agenda for a sustainable future. These are components of the motivation for the study. Preliminary findings show that construction artisans in the informal sector may be the most unprotected, especially in Nigeria, where there is alleged lax implementation of the National Health Insurance Authority Act 2022. It may threaten to achieve Goal 3 because of the relationship between good health and well-being and construction artisans’ productivity. Thus, the study investigates the level of enrolment and causes and suggests measures to improve micro health insurance policy enrolment for construction artisans in the informal sector and, by extension, improve the achievement of Goal 3. The study’s aim is achieved via the following:

1. To assess the enrolment level of the micro health insurance schemes by the informal sector’s construction artisans.

2. To investigate the causes of low enrolment of micro health insurance schemes by construction artisans in the informal sector.

3. To suggest ways to improve micro health insurance policy enrolment for construction artisans in the informal sector and, by extension, improve the achievement of Goal 3.

The construction section comprises the formal and the informal sectors. This study focuses on the construction artisans in the informal sector. It is perceived to be characterised by inadequate coordination and standardisation. This includes lax or without rules and regulations. The construction artisans are skilled tradesmen who are not on a monthly salary but are engaged daily or weekly, depending on the availability of site activities. They can be described as skilled personnel in private practices. The study adopted roofing skills, concreting, joinery, upholstery, electrical, plumbing, tiling, painting, steel fixing, landscaping, carpentry, brick-laying, block-laying, draughtsman, welding and aluminium fixing as the main construction artisans skilled trades in the industry. This agrees with Afolabi et al. (2019) and Ebekozien et al. (2023), who adopted the same trades in their studies. Self-help housing developers or small-scale contractors mostly hire construction artisans in the informal sector to render skilled craftmanship service, and they are disengaged after the project to reduce overhead costs. Artisans can be trained in the informal sector and gain the minimum skills required to make a livelihood (Ebekozien et al., 2023). Besides the sector’s hazardous high rank, decent work (mastery and efficiency) and economic growth are contributions from the artisans to the industry. These contributions face challenges. The researchers’ preliminary findings reveal high reliance on out-of-pocket health payments (Aregbeshola and Khan, 2018), a mechanism that is not sustainable, pushing more below the poverty line of US$1.25 a day poverty line. This may threaten Goal 3 if not checked.

Micro health insurance is a central component of a wider turn towards the promotion of “resilience” in global development (Bernards, 2022). It provides policies to cover four types of risks. This includes property, accidental, health and life losses and is a critical component for the financial inclusion of low-income groups, including the disadvantaged (Uddin, 2017). The study focuses on the health insurance schemes and construction artisans’ willingness to enrol in the scheme to enhance mastery and excellence, which are components of Goal 3 (good health and well-being). In Nigeria, health insurance is broadly divided into three. This includes social, community-based and private health insurance (Umeh, 2018). Bonan et al. (2017) opined that insurance literacy has been a major factor that influenced the demand for micro health insurance in most developing countries, including Nigeria. Inyang et al. (2022) asserted that the rationale for targeting this population segment is to demonstrate sufficient financial capacity in any insurance contract through premium payment. Micro health insurance schemes are tailored to meet the demands of low-income clients. Also, the projects are designed to enhance value and efficiency, accessibility, understanding and simplicity. Ime and Ikechukwu (2017) found that the awareness level of micro health insurance among Nigeria’s low-income earners is poor. Manik and Mannan (2017) emphasised that most developing countries face the same challenges of low awareness. Agboola and Epetimehin (2021) corroborated Ime and Ikechukw’s (2017) assertion but found improvement in acceptance of Nigeria’s micro health insurance products. This may threaten Goal 3 if not addressed.

Previously, Goals like the Millennium Development Goals 2000–2015 and Agenda 21 were executed (United Nations, 2022a). In 2015, the United Nations embraced the 17 Sustainable Development Goals, comprised of 169 targets and 230 indicators (United Nations, 2022b). The Agenda is a plan of action for the planet, people and prosperity and is supported by the New Urban Agenda and African Union’s Agenda 2063 (Ebekozien et al., 2024b). In supporting Agenda 2030, Valencia et al. (2019) opined that the 2030 Agenda is all-inclusive. This study focuses on Goal 3 (good health and well-being) because of the possible impact of construction artisans’ inability to sustain out-of-pocket health payments mechanism on mastery and excellence of work outputs and, by extension, threatens productivity and hinders economic growth of the individual. This is the study’s concern and focus. Good health and well-being are achievable in a sustainable financing health system where low-income construction artisans can afford household health payments through government interventions. Most construction artisans are low-income earners. Goal 3 is pertinent to the micro health insurance system and sustainable economic growth. It could be linked to Goals 1 (end poverty) and 2 (end hunger). Good health would enhance productive employment.

The International Labour Organisation [ILO] (2012) described productive employment as job-producing returns to labour, allowing workers and their households to consume above the poverty line. This attribute is pertinent to Goal 3 and would be facilitated in an affordable and accessible health insurance scheme environment. Good health and well-being would stir decent work. The United Nations (2018) described decent work as a prospect to get productive employment and deliver “living income.” This is all-inclusive because a micro health insurance scheme is a component of social protection and can influence the outcome of decent work. This is the study’s argument. Accomplishing Goal 3 may demand an accessible and affordable financing health system, especially for construction artisans, where the majority are low-income earners. An affordable and accessible health system is required to achieve good health and well-being for construction artisans in the informal sector.

The research employed a qualitative research design to investigate the level of enrolment and causes and suggest measures to improve micro health insurance policy awareness for construction artisans in the informal sector and, by extension, improve the achievement of Goal 3. This is because a qualitative research design intends to describe a lived experience of a phenomenon via collecting data from the participants (Creswell and Creswell, 2018; Jaafar et al., 2021; Ebekozien et al., 2025). This aligns with Afolabi (2022), who engaged 22 executive members of the informal automobile artisans trade to investigate unions’ contributions to safety and health issues prevention. The study adopted constructivism as the research philosophy. Saunders et al. (2012) affirmed that it consists of exploration to explain the interviewee’s actions and emotions. Next, the study employed an inductive approach followed by a qualitative research design. This is because it is an investigative study that gathers feasible measures from knowledgeable interviewees (Creswell and Creswell, 2018). The researchers utilised the phenomenology approach in two locations (Benin City and Lagos, Nigeria). The researchers adopted phenomenology to provide a healthier investigative mechanism to explore the causes of low enrolment in micro health insurance schemes and provide measures to improve them and, by extension, improve the achievement of Goal 3.

The study employed face-to-face semi-structured interviews with 40 participants and achieved saturation at the 35th interviewee. This was established when no newer concepts or ideas emerged from the collected data. The interviewees were captured from Lagos and Benin City, Nigeria, as illustrated in Table 1. The researchers chose these locations to have a good representative highly (Lagos) and not highly (Benin City) populated with construction activities in Nigeria.  Appendix A presents the cover letter and sample of the study’s semi-structured interview questions. The least experienced interviewee was five years of work experience as a construction artisan. The participants include small contractors/self-help individuals, construction artisans in the informal sector, insurance experts, health and safety experts/NGOs, and government officials. The study adopted purposive and snowball sampling techniques. The goal is to ensure that qualified interviewees are engaged in the data collection. Snowball sampling aids in achieving the study’s saturation. For purposive sampling, the technique obtains data from specific groups that are suitably placed. The collected data were analysed manually using a thematic method to offer answers to the main objectives. The interviews were conducted between May and July 2024. The researchers hid the participants’ identities, but their posts showed they knew about micro health insurance schemes. It took 50 min on average for each interview. In line with Corbin and Strauss (2015) and Aigbavboa et al. (2023a, b), the study employed narrative, themeing, emotion and attribute coding methods. The researchers employed quality evaluation strategies to strengthen the reliability of the data, as illustrated in Table 2. This would enhance the credibility and dependability of the results. Eighty-nine codes were generated and re-grouped based on occurrence, frequency and reference. Ten categories were generated from the 89 codes. Examples of the codes include poor awareness, poor funding of micro health insurance schemes, lax expertise and understanding of the micro insurance market space, extreme poverty, poor medical services, uneducated clients/customers/consumers, fear of sustainability, high running costs, low customers/clients, unaffordable products to clients/customers/consumers, weak distribution networks and communication/networking. Others are integrated social health protection plans, micro healthcare funding, social health policy plans, financial risk protection, National Health Insurance Authority Act 2022, National Health Insurance Scheme Act 2004, awareness and communication/networking issues, and design promotional packages to attract construction artisans. Three themes emerged from the ten categories.

Construction artisans in the informal sector’s enrolment in the micro health insurance schemes is one area under-studied, particularly how it would improve achieving Goal 3. This research attempts to investigate the causes of low enrolment in micro health insurance schemes by construction artisans in the informal sector and offer ways to improve the enrolment into micro health insurance schemes and, by extension, improve the achievement of Goal 3.

Theme one assesses the enrolment level of the micro health insurance schemes by the informal sector’s construction artisans. The findings show that the informal sector’s construction artisans’ enrolment is low. Of the 28 construction artisans engaged, none was enrolled. Six of the artisans are aware of the schemes but have reservations. Also, the findings show that besides the low level of enrolment in micro health insurance schemes across the study areas, there is an absolute lack of awareness concerning micro health insurance schemes and their right to affordable and accessible good health facilities at the primary health centres (majority of the artisans). Participant P37 says, “ …. when you hear politicians emphasising that the government is almost achieving universal health coverage, it is a political statement. Do you know that financing health from out-of-pocket payments has done more harm than good to many of these artisans and pushed many to below extreme poverty level ….” Findings agree with the World Health Organisation (2010) and Aregbeshola and Khan (2018). The World Health Organisation (2010) projected that over 150 million people incur disastrous health expenditures. The majority are from developing countries and over 100 million are pushed into extreme poverty because of the out-of-payment financing health. Aregbeshola and Khan (2018) asserted that most low-income countries are battling the issue of poverty. Most people who benefit from the National Health Insurance Scheme that commenced in 2005 are regular income earners in government and private organisations (P33, P35, P38, & P40). The National Health Insurance Authority 2022 Act allows for private individuals.

Participant P35 says, “… … low enrol of low-income earners into micro health insurance schemes without intervention from an international organisation or government is evident in most developing countries, including Nigeria. Where do we expect the informal sector’s construction artisans to maintain regular healthcare insurance subscriptions? …. ” Findings agree with Ime and Ikechukwu (2017) and Peterson et al. (2018). Ime and Ikechukwu (2017) found that the awareness level of micro health insurance among Nigeria’s low-income earners is poor. Agboola and Epetimehin (2021) corroborated Ime and Ikechukwu’s (2017) assertion but found improvement in the acceptance of Nigeria’s micro health insurance products. Manik and Mannan (2017) emphasised that most developing countries face the same challenges of low awareness. Peterson et al. (2018) investigated a private micro health insurance scheme in Lagos that covered the informal sector and discovered declining enrolment of clients. Participant P22 says, “ …. .I’m aware that Edo State has an insurance scheme. Still, I refused to register because my elder brother, who is a federal government civil servant in one of the agencies in Edo State, complained on several occasions about the quality of medical services received because he is a subscriber of the National Health Insurance Scheme where he pays 10% for every medical bill … … Why should I subscribe to such a platform where one is treated as an inferior? ….” A quick check on the Internet confirms various health plans are available in the Edo Health Insurance Scheme. From the Edo State Government website, as reported by Igiekhume (2022), “ … .With N50 a day, one can access quality healthcare. This token of N50 translates to N1,500 per month and N18,000 per year. The various healthcare packages include the Equity, Students, and Bronze packages at the rate of N18,000 per annum, the Silver package at the rate of N35,000 per annum, the Gold package at N68,000 per annum, and the Enhanced private plan (Platinum) at N75,000 per annum ….” This implies that even with N75,000 (US$1/N1,400) per year, one is not sure of good medical services when needed. There is no way the enrolment will improve because many prospective clients/customers know the poor services rendered by the healthcare providers enlisted in the schemes (majority).

Theme two presents the causes of low enrolment into micro health insurance schemes by construction artisans in the informal sector. Majority of the causes are human-related factors (majority). This includes poor awareness and poor funding of micro health insurance schemes, lax expertise and understanding of the micro insurance market space, extreme poverty, poor medical services and uneducated clients/customers/consumers. Others fear sustainability, high running costs and low customers/clients (business unattractive to investors), unaffordable products to clients/customers/consumers, weak distribution networks, and communication/networking barriers. Participant P38 says, “ …. without affordable and accessible micro health insurance scheme through interventions such as health insurance subsidy, please don’t expect to see any improvement in enrolment of construction artisans. I guess you know what Nigerians are going through now. How many artisans get jobs daily to subscribe to health insurance premiums? Removing the fuel subsidy and the local currency float compounded issues for Nigerians. The outcome is rising extreme poverty ….” Regarding extreme poverty and poor funding of micro health insurance scheme, findings agree with Aregbeshola and Khan (2018) and Umeh (2018). Aregbeshola and Khan (2018) discovered that many Nigerians financing the health system rely on an “out-of-pocket” health payment approach. This is because of the rise in poverty headcount, especially among construction artisans in the informal sector. The impact of this approach could be catastrophic and increase households’ poverty rate. Umeh (2018) found that a segmented health insurance fund pool, a poorly funded primary health care system and extreme poverty are barriers to universal health coverage. The micro health insurance scheme is a component of the universal health coverage tailored to address the health issues of low-income earners, especially in the sub- and rural locations.

Regarding extreme poverty and uneducated issues as contributory causes to the low enrolment, findings show that it is difficult to upgrade the financial status of this group of people because of the nature of employment. Participant P13 says, “ …. for the past week, I have been coming here, but no client/customer has engaged me. I’m ready to collect half-day pay (N3,000), but no customer and my children are not finding it funny ….” This is one out of many who sometimes get engaged five times in one month and have bills to settle. Even in the formal sector, majority are categorised as junior staff (P4, P33, P38, & P39). Results align with Hughes and Ferrett (2016) and Ogundipe et al. (2018). Hughes and Ferrett (2016) and Ogundipe et al. (2018) found that the built environment artisans belong to the junior staffers group. The challenge of good pay to sustain a subscription may be an issue. Also, it agrees with Onoka et al. (2013) and Umeh (2018), who found that community-based health insurance schemes are unattractive because of sufficient money to pay premiums.

Also, findings show that the low quality of healthcare and unattractive benefits packages for investors contribute to low enrolment. The need to improve services rendered to attract construction artisans and other informal sector trades to achieve all-inclusive health coverage and achieve Goal 3 cannot be over-emphasised. This is missing. “ …. my cousin, who is a medical practitioner, and I visited a family friend who was diagnosed with malaria. The malaria has been off and on for the past three weeks with insignificant improvement. When my cousin evaluated the medications administered to him, he was surprised by the quality of medication administered to such high-resistance malaria, even with the laboratory test results. We pleaded with my cousin because it became an issue with the health provider enlisted under the National Health Insurance Scheme ….” Results align with Onoka et al. (2013) and Umeh (2018), who found that community-based health insurance schemes are unattractive because of the unavailability of drugs, long waiting hours and inadequate diagnostic equipment. A lack of trust in the scheme within the stakeholders compounds this.

Based on the poor level of enrolment and the identified issues, providing ways to improve the enrolment and, by extension, improve achieving sustainable development goal 3 is apposite. Despite the National Health Insurance Authority Act 2022, findings show low enrolment in micro health insurance schemes by construction artisans in the informal sector. “ …. some of the clauses cannot be implemented in a country dominated more by the informal system. For example, every person resident in Nigeria must obtain health insurance. How do you convince and enforce it on an irregularly engaged artisan to enrol in a micro health insurance scheme?” said Participant 40. A holistic reform to reawaken the primary health sector is inevitable. Findings suggest that governments (federal, state and local) should move to action as available legal reforms, such as the National Health Insurance Authority Act, provide new tools to address the needs of low-income earners, including construction artisans in the informal sector. The new law mandates the government to prioritise the citizen’s health investments towards health for all. “ … . the health for all slogan is possible if there is a structure of fruitful public-private partnerships and sustainable social contract … …” said Participant P10.

Findings suggest an integrated social health protection plan tailored to mitigate financial and other issues hindering micro health insurance schemes in Nigeria. Participant P36 says, “… … even some developed countries have some form of social health protection for the low-income earners to enhance inclusiveness and coverage. Why is the Nigerian Government refusing to do what is needed for low-income earners in the informal sector rather than allowing them to use out-of-pocket health payments that are not sustainable and anti-economic growth? It is a threat to Goal 3 ….” Findings agree with Aregbeshola and Khan (2018), who suggested increasing micro healthcare funding and offering social health policy plans to mitigate informal out-of-pocket health methods. Health insurance intervention in the form of subsidy will mitigate financial risk protection, which is currently absent among construction artisans in the informal sector. Findings opine that health challenges from construction artisans in the informal sector that are not properly managed could negatively impact the productivity and efficiency of the products (Goal 3). “ …. the National Health Insurance Authority Act 2022, which repeals the National Health Insurance Scheme Act 2004, is all-inclusive but lacks implementation. This current study would be unnecessary if there was machinery in place to enforce implementation. It is an all-inclusive working policy document that provides, promotes, and integrates health insurance schemes in Nigeria for all groups ….” said Participant P37.

Regarding awareness and communication/networking issues, findings suggest integrating the network providers as part of their corporate social responsibility. This is because most low-income earners use mobile phones. Health insurance policy messages can be communicated to the caller while waiting to connect the call (majority). The operators could design promotional packages to attract construction artisans (P4, P7, P9, P13, P22, P25, P30, P34, & P38). Healthcare-related NGOs could be useful in creating awareness on the doorsteps of these artisans and explaining the benefits (majority). Findings agree with GSMA Intelligence (2018), which found that more than 80% of Nigerians use GSM, which is projected to rise to 130 million by 2025. Participant P6 …. says, “ …. awareness should be all-inclusive and grass-root stakeholders channels engaged. This includes religious leaders, community young leaders, builder materials retailers, media, professional associations, community health institutions, and specialised health professionals. They are agents that represent in a unique way to raise awareness about health insurance and facilitate uptake by construction artisans in the informal sector ….” Besides increasing infrastructure and consistent health capital investment to address basic issues, findings recommend negotiating and prioritising crucial structural changes with pragmatic settlements to attract capital from other sources and provide a favourable environment for higher health investments. Findings agree with the Federal Ministry of Finance, Budget and National Planning (2021), which opined the need to focus on the domestic product of the non-oil sector to robust the economy and fast-track the transformation and renowned hope of President Tinubu. Sufficient revenue to finance health systems is critical for the rise in micro health insurance scheme enrolment, a component of universal health coverage (majority). Findings agree with Umeh (2018), who suggested increasing financial sustainability and allocating more funds to health in government budgets. The outcome would improve achieving Goal 3.

Besides stakeholders’ awareness, especially informal sector clients, revitalising the responsibility of the National Health Insurance Authority Act 2022 regulators to promote, regulate and integrate health insurance schemes cannot be over-emphasised. Participants P16, P24, P29 & P31) affirm that they should ensure that health insurance schemes are accessible and affordable for every Nigerian and subsidise the low-income packages to improve the enrolment of in-takes. Participant P31 says, “ …. the regulators, including the Health Maintenance Organisations, Mutual Health Associations, and Third-Party Administrators, and accrediting insurance companies have a responsibility to ensure a basic minimum package of health services for all Nigerians across all health insurance schemes operating within the country ….” A lot of work is needed in this regard because of the report on the inferiority of subscribers. The government should handle health insurance schemes for low-income earners as a top social responsibility (P5, P16, P24, P28, P33, & P38). It must not be profit-driven to improve achieving Goal 3. Mitigating the underinsured population will improve the achievement of Goal 3 because micro health insurance schemes will enhance construction artisans’ health and well-being. This is germane, and it is the study’s motivation and goal.

In summary, besides this study’s data saturation at the 35th participant, key questions were targeted to address each objective. Questions 5, 6 and 11 (refer to  Appendix A) were tailored to proffer answers to address this study’s three objectives. The collected data from the 40 participants, majorly artisans (28), were coded and analysed. Responses from Question 5 provided answers to Objective 1. Responses from Question 6 provided answers to Objective 2. Lastly, responses from Question 11 provided answers to Objective 3.

Based on the reviewed literature and results, there is a low enrolment of the informal sector’s construction artisans into micro health insurance schemes in Nigeria. This is of concern because the scheme is mandatory for all Nigerians and legal residents in line with Section 1 of the Act that established the National Health Insurance Authority 2022. It reveals the lax implementation of the Act as it affects construction artisans in the informal sector. This research has reawakened healthcare policymakers to review the implementing and enforcing guidelines, especially for informal sector stakeholders, including construction artisans. This is because of the 28 direct construction artisans that participated, none has enrolled for a supposed mandatory scheme for all Nigerians. Findings reveal poor awareness and funding of micro health insurance schemes, lax expertise and understanding of the micro insurance market space, extreme poverty, poor medical services and uneducated clients/customers/consumers as the causes of low enrolment of micro health insurance schemes by construction artisans in the informal sector. Others fear sustainability, high running costs, low customers/clients (business unattractive to investors), unaffordable products to clients/customers/consumers, weak distribution networks and communication/networking. The causes were human-related factors and could be avoided with all-inclusive measures and developing countries’ governments taking the lead.

As part of this study’s implications, it provides major stakeholders such as the governments (federal, state and local government levels), small contractors/self-help individuals (users of informal artisans), construction artisans in the informal sector, insurance experts and health and safety experts/NGOs the platforms to engage in possible measures that will assist improve micro health insurance policy enrolment for construction artisans’ to achieve Goal 3 before 2030. Besides the identified measures tailored towards attaining Goal 3, other SDGs linked with good health and well-being for artisans’, such as Goals 8, will be accomplished. This is germane to promoting all-inclusive, sustainable economic development. Results intend to stir researchers to inform critical stakeholders on improving micro health insurance policy enrolment for construction artisans to accomplish SDG 3. The research findings would assist in a better understanding of micro health insurance policy enrolment issues for construction artisans to achieve SDG 3.

Thus, this study suggested feasible measures for improving micro health insurance policy enrolment for construction artisans in the informal sector and, by extension, improving the achievement of Goal 3. The pinnacle is to achieve Goal 3 via the following recommendations:

1. First, a multi-ways mechanism that will boost enrolment of the informal sector’s construction artisans into micro health insurance schemes cannot be over-emphasised. An existing Act 2022 makes it mandatory for every Nigerian to enrol in a health insurance scheme and should be enforced. Still, it faces enforcement and implementation issues regarding low-income earners in the informal sector. The alleged failure of government (regulatory agencies) to do what is needed may have caused it because the new law represents a sustainable social contract to accelerate Nigeria’s progress towards health for all. Enforcing such rules in a system that cannot be formalised and compounded with extreme poverty and the inability to pay premiums may be challenging.

2. Thus, the government should embrace the micro health insurance schemes of construction artisans as a social responsibility by raising sufficient revenue to finance the health systems to provide health coverage for low-income earners at an affordable and accessible subsidy. This is critical to enable them to have access to quality healthcare services. The outcome will translate to improving the achievement of Goal 3 on or before 2030 because it will reduce the underinsured population.

3. Awareness should be given attention by regulatory agencies, health facilities providers and NGOs through various channels and promotion platforms, including social networks. Incentives and other promotional packages could attract construction artisans to enrol in one of the schemes.

This study has limitations. The primary data for the research were sourced from Lagos and Benin City, Nigeria. The researchers’ chose these cities to cover a good representation of the highly populated and densely populated cities. Also, the study employed a qualitative research design. Still, the study’s results are strong because of the in-depth reviewed literature and data saturation. Besides expanding the scope of the study and quantitative approach in future studies, the research recommends the need to relate the impact of micro health insurance schemes to other SDGs, such as Goal 8 (decent work and economic growth) and evaluate its impact. Also, consideration could be given to validating emerging constructs in future research and adopting some of the findings in other developing countries.

The authors thank the participants for providing scholarly contributions to enhance the findings of this study and also thank Dr S. S. Umar (Rector, Auchi Polytechnic) and his team for creating an enabling environment to contribute to this research. The authors appreciate the comments, suggestions and recommendations provided by the anonymous reviewers, which honed and strengthened the quality of this manuscript during the blind peer-review process.

Funding: The research was funded by the Faculty of Engineering and the Built Environment and CIDB Centre of Excellence (No. 05-35-061890), University of Johannesburg, South Africa and Ministry of Higher Education Malaysia for Transdisciplinary Research Grant Scheme (TRGS) (No. TRGS/1/2022/USM/02/3/2).

Dear Participant,

Request for Interview.

In developing countries, the informal construction craftspeople are vital to economic growth. Governments encourage enrolment into micro health insurance schemes to sustain artisans’ well-being and achieve universal health coverage. The peculiarity associated with the informal construction artisans may hinder the scheme enrolment, particularly in Nigeria. It may threaten to improve achieving sustainable development goal 3 (good health and well-being). Thus, this study is titled: Appraising Informal Sector’s Construction Artisans’ Health Insurance Policy Enrolment to Achieve Sustainable Development Goal 3: Issues and Solutions. Specifically, this study is proposed to be accomplished through the following objectives:

1. To assess the enrolment level of the micro health insurance schemes by the informal sector’s construction artisans.

2. To investigate the causes of low enrolment of micro health insurance schemes by construction artisans in the informal sector.

3. To suggest ways to improve micro health insurance policy enrolment for construction artisans in the informal sector and, by extension, improve the achievement of Goal 3.

The questions for the interview are going to be within the stated objectives. Also, your responses will be collated and analysed with other participants. This will make up a valuable, helpful contribution to achieving the success of this research. All information provided will be handled with the utmost confidentiality.

Hence, your valuable time and input in answering the questions and making other contributions will be highly appreciated. Note that the researchers will findings from this study with the participants who indicate interest via email address to be supplied.

Kind regards.

Yours faithfully,

(Researchers)

1. For record purposes, what is the name of your firm?

2. What service does the organisation render?

3. What is your position in this firm, and how long have you been working?

4. Are you knowledgeable about micro health insurance and SDGs, particularly Goal 3 (health and well-being)?

5. Can you assess the enrolment level of the micro health insurance schemes by the informal sector’s construction artisans?

6. From your perception, what causes low enrolment of micro health insurance schemes by construction artisans in the informal sector?

7. If yes to Question 6, can you identify the cause(s)?

8. If not, why do you think so?

9. Can these hindrances be mitigated to achieve sustainable development goal 3 by informal sector construction artisans embracing micro health insurance enrolment?

10. If yes to Question 9, can you give a practical example of how these challenges can be mitigated?

11. What are the possible ways to improve micro health insurance policy enrolment for construction artisans in the informal sector and, by extension, improve the achievement of Goal 3?