Factors related to ownership of health insurance cover in Navakholo, Kakamega County, Kenya: sub-county level results based on community household register

Abstract

Background: In concert with international commitments, the Government of Kenya identified universal health coverage (UHC) as one of its four priority agenda to enable its populations have access to health care without financial duress. Nevertheless, only about 19.5% of the Kenyan population is enrolled in any insurance health cover. Since 2016, Amref Health Africa and PharmAccess Foundation have been implementing the innovative partnership on universal and sustainable healthcare (iPUSH) programme in Navakholo sub-county of Kakamega County. The objective of this study is to examine ownership of health insurance cover among women of reproductive age (WRA) in Navakholo sub-county, Kakamega County. Methods: We analysed data captured during household registration conducted in February 2021. The dataset consisted of a total of 148,957 household members within 32,262 households, 310 villages, and 32 community health units. The data had been collected using mobile phones by trained community health volunteers (CHVs) and transmitted using the Amref electronic data management platform and reposited in a server. After much review of data quality, variables qualifying were analysed through descriptive and causal methods using STATA software. Results: Insurance coverage in Navakholo sub-county stood at 11% among women aged 15-49 years who were either spouses of the head of household or heads of households themselves. This is much lower than the national aggregate reported from sample surveys, but higher than the 7% found in the same survey for the Western region where Navakholo is situated. Social determinant variables – age, perceived condition of the household, and wealth ranking – are highly significant in the relationship with ownership of health insurance cover while measures of reproductive health and health vulnerability are not. Conclusions: In Navakholo sub-county of western Kenya, health insurance coverage is lower than the national aggregate estimated from sample surveys. Age, perception of household condition, and wealth ranking are very significantly related to ownership of a health insurance cover. Frequent household registrations should be conducted to help monitor the trends and impact of health insurance campaigns. Training – upstream and downstream – on community household registration and data processing should be conducted to arrive at better quality data.