Determinants of Uptake and Utilization of National Hospital Insurance Fund Medical Cover by People in the Informal Sector in Kakamega County, Kenya

Abstract

Low and middle-income countries have extended state sponsored Social Health Insurance (SHI) to people outside the formal sector to enhance access to healthcare. However, in spite of the relatively low costs of signing up and the benefits offered by SHIs, uptake rates are very low among the informal sector populations. The objective of this study was to investigate factors affecting participation of people in the informal sector in the National Hospital Insurance Fund (NHIF) scheme in Kakamega County, Kenya. This cross-sectional study was conducted in Kakamega County in Western Kenya. The study employed a mixed methods designs approach. In the first phase of the study, 400 participants were recruited using both probability and non-probability sampling methods; 400 persons engaged in informal sector activities were recruited through random sampling. In the second phase of the study, 24 key informants and 5 groups consisting of 8-12 persons were purposively selected for in-depth interviews and Focus Group Discussions respectively. The study established that people in the informal sector with higher income (> Kshs.10, 000) are more likely to enroll (odds ratio 2.21 with 95% CI: 1.07 to 4.03) compared to those with low incomes and similarly, higher level of education was significantly associated with enrolment in NHIF scheme (odds ratio 31.07 with 95% CI: 17.19 to 87.94). Rigid scheme design features create difficulties for people in informal sector to participate. In conclusion, policy decisions should focus on interventions directed at educating poor populations, people with low educational levels and those working outside formal employments on the benefits of subscribing to the NHIF scheme in Kenya. The study recommends subsidies or waivers to increase affordability of participation in the NHIF scheme, particularly for people with low monthly incomes.

Factors affecting the Utilization of Social Health Insurance by the General Population in Bhaktapur Municipality

“…A similar study done in Kakamega country in Western Kenya with 400 participant showed that people with higher income are likely to register in the scheme (OR 2.21 with 95% CI:1.07 to 4.03) which reflects similarity with our study. 9 My study showed that the source of information plays a significant role in the utilization of the scheme (0.025). Most of the participant had heard about the scheme from their family members (53.2%) yet this result contrast with a cross sectional study done by Macharia et al that showed no significant association among source of information (0.770).…”

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

“…NHIF uptake in the four counties was similar, ranging from only 21-25%. This is lower than the uptake rates described in Kakamega, Muranga and amongst women in central Kenya likely because our study covered largely a peri-urban and very rural population (11,23).…”

“…Importantly, that study did dig deeper into the actual kind of knowledge participants had on NHIF and found that only 34% had the correct knowledge. It is therefore possible that despite the high rates of awareness we recorded , the actual knowledge held may not be correct (23).…”

“…For marital status, some of the studies have shown that those who are married are likely to enroll in NHIF because of the nancial support they have from their partners and for singles register low enrollment on NHIF (23).…”

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

“…(22) For marital status, some of the studies have shown that those who are married are likely to enroll in NHIF because of the nancial support they have from their partners and for singles register low enrollment on NHIF. (23) There is a need to improve health service delivery and nancing yet there is paucity of data on NHIF awareness uptake and factors affecting its uptake in western Kenya. We set out to ll this gap.…”