Determinants for participation in a public health insurance program among residents of urban slums in Nairobi, Kenya: results from a cross-sectional survey

Abstract

BackgroundThe government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city.MethodsThe study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program.ResultsOnly 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance.ConclusionsThe proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.

Strategies to Enhance Utilization of National Hospital Insurance Fund Scheme Medical Cover by Informal Sector Populations in Kakamega County, Kenya

“…The observed poor participation in the NHIF scheme can be explained by unmet health care needs for NHIF members, especially when members of the NHIF scheme still have high out of pocket expenditure like costs of travel to accredited health facilities, buying drugs like nonmembers of the scheme and inflexible scheme design features such as strict datelines to remit contributions. This finding corroborates with findings of a similar study findings by Kimani et al [18] in which he reported that NHIF scheme design features were an impediment to enrolment by people living in the slums of Nairobi, Kenya.…”

“…Poor participation by people in the informal sector in scheme has been blamed on the difficulties they face. People in the informal sector face difficulties of low and irregular incomes; this makes them unable to make timely contributions [18]. People in the informal sector also face difficulties created by inflexible scheme design features such as penalties, inflexible payment schedules, non-portability of scheme services, cumbersome enrolment and contribution procedures [27].…”

Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria

“…This is in agreement with findings in some previous studies. 1,24 Earlier works, 34,44 have made useful suggestions about technical design of health insurance such as frequency and amount of contribution that will suit different socioeconomic groups of people. Also innovative ways of fund-raising at the domestic level especially on goods purchased and services sought by the better -off in the society as a source of revenue collection to help the poor and the needy for a sustainable health-care financing scheme have been suggested.…”

Sociodemographic and behavioural factors associated with body mass index among men and women in Nairobi slums: AWI-Gen Project

“…For example, in this study among adults aged 40 to 60 years, hypertension prevalence was 25.6% in the slums of Nairobi: 58.9% of men were not aware of their hypertension status, 28.2% of women were not aware and only 50% of women and 30% of men had controlled blood pressure [10]. Kimani et al, previously reported high levels of catastrophic health expenditure among slum residents with up to 90% of the population not accessing any form of health insurance [11]. Overweight and obesity are largely preventable.…”