Awareness, Uptake and factors associated with NHIF uptake in Western Kenya: A case of 4 counties - Busia, Trans Nzoia, Vihiga and Siaya

Abstract

Background Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary hence geared to those in formal employment who represent only 16.4% of the population. To improve the voluntary uptake of the scheme, it is important to have increased awareness as well as implement strategies that address factors that currently affect NHIF uptake. Methods This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October and December 2018. It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive statistical analysis and multiple logistic regression were conducted using STATA version 15. Results Out of a representative sample of 3597 participants interviewed, NHIF awareness was noted to be 81.5%, with low uptake in the four counties ranging between 21–25%. Being older than 69 years, having a low level of education and income status as well as lower health risk were significantly associated with low rates of NHIF uptake. Conclusion Despite high rates of NHIF awareness noted in this study, there is still very low uptake to this scheme in rural western Kenya especially among those with low socioeconomic status and risk of chronic illnesses. There is need for further qualitative studies to explore contextual factors affecting NHIF uptake.

Uptake of Health Insurance and Its Associated Factors Among Informal Sector Workers in Dar Es Salaam, Tanzania

“…The positive effect of the higher education levels enhances the health seeking behavior of individuals, better knowledge and understanding about the effects of illness on health care expenditure. This finding was supported by that higher level education is associated with enrolment into health insurance (Fadlallah et al, 2018;Mwaura, et al, 2021).…”

Uptake of health insurance in Malawi in 2019-2020: Evidence from the Multiple Indicator Cluster Survey

“…The implication of the association between wealth and insurance uptake for settings like Malawi would be to consider a minimal amount of health insurance schemes for the less privileged since the less privileged are the most marginalized in uptake of health insurance. Persons with low education level have lower uptake of health insurance as observed in other similar settings like Kenya [20] [24] [25]. Level of education proxies literacy level therefore people with little knowledge and understanding on universal health care have low use of health insurance [20].…”

“…A study in SSA by Barasa et al found that wealthier individuals were more likely to have a health insurance compared to those with less income [2]. Generally, the higher an individual’s wealth level is, the more likelihood he will participate in a health care program in SSA [2] [19] [20] and this is similar to what was observed in China, Spain and USA [18] [21] [22] [23] [24]. The implication of the association between wealth and insurance uptake for settings like Malawi would be to consider a minimal amount of health insurance schemes for the less privileged since the less privileged are the most marginalized in uptake of health insurance.…”

“…Persons with low education level have lower uptake of health insurance as observed in other similar settings like Kenya [20] [24] [25]. Level of education proxies literacy level therefore people with little knowledge and understanding on universal health care have low use of health insurance [20]. For health insurance uptake to improve then people should be well informed on the same hence literacy in the health systems of a country should be undertaken [20].…”

Determinants of Primary Healthcare Services Access by National Health Insurance Fund Capitated Members in Uasin Gishu County, Kenya

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