Determinants of Health Insurance Uptake by Urban Informal Sector Workers in Nairobi and Machakos, Kenya
Muiya, Bernard Munyao
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The informal sector in Kenya had employed 12.5 million people by 2015 who contributed substantially to the national GDP yet they are often excluded in healthcare systems and are therefore unlikely to access health benefits unlike persons in formal employment. This is despite the high risks associated with their work. Even though health insurance increases access to healthcare services and improves financial risk protection, only a few of these workers have a cover in Kenya. This study investigated the determinants of health insurance uptake among urban informal sector workers in Nairobi and Machakos Counties. The objectives of the study were to; (i) examine enrolment status and patterns into health insurance schemes by informal sector workers, (ii) explain the level and source of awareness of health insurance among informal sector workers, (iii) establish factors of enrolment into health insurance schemes by informal sector workers, and (iv) establish the key determinants of enrolment into health insurance by informal sector workers. The study used four hypotheses to test for independence between enrolment into health insurance schemes and awareness of health insurance, source of health insurance information, individual and household characteristics of informal sector workers. The Health Belief Model, the Weberian Stratification model and Rational Choice Theory guided the study. Cross-sectional survey design was used. Data were collected through a structured interview schedule and a focus group discussion guide. Four hundred and fifty six respondents from informal sector workers, healthcare facilities and NHIF officials were sampled through both proportionate (cluster) and non-proportionate (purposive) sampling techniques. Quantitative data were analyzed using SPSS through Chi-square, Cramer’s V and Principal Component Analysis. Qualitative data were analyzed thematically. The study established that enrolment in health insurance for the sampled population was low (15 per cent). Even though there were high levels of awareness, there was limited understanding of health insurance benefits. The National Hospital Insurance Fund had an enrolment rate of 63 per cent compared to private health insurance schemes. Family members and friends were the popular source of awareness (43 per cent) of health insurance. Eight variables (marital status, income, age, level of education, number of dependants, reading of newspapers, television viewing, and awareness of health insurance) were significantly related to enrolment into health insurance. The relationships were, however, weak. Principal Component Analysis (PCA) extracted two components with high loadings on level of education, television viewing and reading of newspapers (Component 1) and number of dependants and marital status for component 2. This study recommends that health insurers conduct health insurance education through intensive outreach programmes and design flexible payment schedules to accommodate the irregular incomes for the informal sector workers in order to increase enrolment.