Background: In low- and middle-income countries (LMICs) health financing systems has been dependent on out-of-pocket payments (OOP). This type of payment is thought to increase income to finance health care but it’s unaffordable to economically disadvantaged persons. Health insurance was introduced in order to reduce catastrophic health expenditure caused by OOP but its implementation to informal sector workers is a challenge. Therefore, this study examines the coping strategies for managing health care costs among informal sector workers in Dar es Salaam, Tanzania. Methods: This cross-sectional descriptive study was conducted between September and December 2020 to 889 informal sector workers. The study respondents were randomly selected and questionnaire was used to collect data. Chi-square test and multivariate logistic regression were used to analyze data through the use of Statistical Package for Social Sciences (SPSS) version 23. Results: The findings showed that the mean age of the respondents was 34.8 years (SD±10.4) and majority, (90.1%) of the respondents were uninsured. The methods to carter for medical expenditures were cash payments (p=0.297; 95%CI=0.195-0.452), selling assets (p=0.672, 95%CI=0.507-0.891) and borrowing money (p=0.578, 95%CI=0.412-0.811). Conclusions: The health care financing methods that the informal sector workers use in order to access health services are effective in reducing short run problems of health care accessibility but it contributes to impoverishment. Designing an affordable insurance scheme with consideration of the social economic aspects of individuals will improve uptake to insurance schemes and hence achievement of the Sustainable Development Goals (SDGs).

Background: World Health Organization's agenda on Universal Health Coverage (UHC) calls for a protected accessibility to health services. Globally, 1.3 billion people lack access to health services and around 61% are on informal employment. The informal employment exposes individuals to more risks

Health insurance is a viable strategy to facilitate accessibility of health care but it favors the formal sector workers while leaving behind the informal sector workers who are the majority. This mixed methods study involved 889 informal sector workers from Dar es Salaam, Tanzania. Income, membership to economic groups, education, age, insurance regulations, fragmentation of insurance providers, cultural beliefs and low priority on health insurance were significantly associated with uptake of health insurance. Low uptake of health insurance increases inaccessibility of health care. Subsidizing the premium and using innovative strategies to increase understanding will improve health service accessibility.