Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand

Abstract

This paper contributes to analysing and understanding the demand for (social) health insurance of informal sector workers in Kenya by assessing their perceptions and knowledge of and concerns regarding health insurance and the Kenyan National Hospital Insurance Fund (NHIF). It serves to explore how informal sector workers could be integrated into the NHIF. To collect data, focus group discussions were held with organized groups of informal sector workers of different types across the country, backed up by a self-administered questionnaire completed by heads of NHIF area branch offices. It was found that the most critical barrier to NHIF enrollment is the lack of knowledge of informal sector workers about the NHIF, its enrollment option and procedures for informal sector workers. Inability to pay is a critical factor for some, but people were, in principle, interested in health insurance, and thus willing to pay for it. In sum, the mix of demand-side determinants for enrolling in the NHIF is not as complex as expected. This is good news, as these demand-side determinants can be addressed with a well-designed strategy, focusing on awareness raising and information, improvement of insurance design features and setting differentiated and affordable contribution rates.

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

“…Previous studies have reported similar findings that low level of trust in government public policies was responsible restraining people from participating in a prepayment scheme in Cambodia and was also shown in a Nigeria study as a likely factor that might dissuade people from participating. 12,30 However, this is in contrast to a study by Mathaeurs and others 6 where people did not express any element of distrust in government managing insurance funds. The low level of trust in government programs could result from peoples experiences in previous programs that either failed or whose financial resources were mismanaged.…”

“…This attitude is similar to findings in preceding studies, which have shown that potential beneficiaries and health policy makers were interested in health insurance and expressed their willingness to participate. 6,34 Despite this favorable attitude to health insurance scheme, majority of African countries are yet to adopt it, among those who have adopted it, some are still struggling with expanding it. This is the current situation in Nigeria.…”

“…OOP payment predisposes individuals and households to exhaust personal savings, borrow or loan money, sell properties and livestock, and sometimes pay by installments when permitted. [5][6][7] Capacity to access health care may be worsened as ill-health reduces or brings to a halt the earning capacity of a household member, and if the head of the household is affected, the basic needs of other members are negatively affected, including food consumption and child education. 8,9 Adequate knowledge and awareness about a prepayment scheme and its benefits are important for (its) implementation and sustainability.…”

“…[10][11][12][13] Similar findings were reported in some other developing countries. 6,14,15 Certain sociodemographic factors such as sex, educational and socioeconomic status are known to influence the awareness about available health-care services and thus, could either promote or serve as a barrier to the uptake of available health-care services. [16][17][18][19] These factors could differently affect the uptake of such services among people of differing sociodemographic factors in the same setting.…”

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

“…Private health insurance is available but predominantly accessible to the middle and higher-income groups, while, the Community Based Health Insurance (CBHI) schemes still have limited coverage countrywide [23,22]. The benefits of NHIF membership include coverage of inpatient expenses (costs of bed, meals, treatment and drugs) with the share of expenses covered determined largely by the type of health facilities (Hospitals, Nursing Homes and Dispensaries).…”