Determinants of Enrolment in National Hospital Insurance Fund among the Community Members in Uasin Gishu County, Kenya
Wanjiru, Emma Phyllis
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In Kenya around a million people are pushed to poverty annually paying for healthcare out of pocket. Prepayment and risk pooling has been used to avoid the risk of paying for healthcare from household income at time of illness. Universal health coverage is part of the four main government agenda from 2018-2022 which targets to have 100% enrollment in NHIF. Despite increased NHIF benefits in 2015, enrolment in Uasin Gishu remains low at 16.6% compared to the national average at 19%. The low enrolment in health insurance causes people to pay for healthcare out-of-pocket which is a deterrent to seeking health care. This study aimed to establish the determinants of enrolment in National Hospital Insurance Fund among the community members in Uasin Gishu County, Kenya. It assessed the socio-economic factors, perception of accountability and the influence of the perceived quality of care in accredited health facilities. A cross-sectional study design was used. The county and the ward were selected purposively for the research. The county represented the majority of the Kenyan economic engagement and Kapsaos ward had a majority, (26%) of hospital bills waived in Uasin Gishu county. The number of households per village was determined proportional to size of village and simple random sampling was used to sample the households to interview. A sample of 334 households was interviewed (N=334). Data was collected using structured questionnaires which were administered by the researcher. The researcher also interviewed 11 key informants. Pretesting was done in Kapsoya to ensure validity. Data was analyzed using SPSS version 20 and Pearson’s Chi-square test was done with corresponding 95% confidence interval to establish association between the dependent and independent variables. The level of statistical significance was at p-value <0.05. Logistic regression was done for factors that were significantly associated with enrolment in NHIF. The findings of the study revealed that enrolment into NHIF in the area was at 35%. The factors that influenced enrolment were having secondary education [OR 3.862, CI = 1.347; 11.074; std. Err. 0.537; p=0.012], being in the professional and technical occupation [OR 1.978; CI = 0.679, 5.766; std. Err. = 0.546; p=0.011], income of Ksh. 16,000-20,000 [OR =2.652 CI=0.716, 9.831; std Err. = 0.668; p= 0.044], preference for private health facilities, [OR=8.006 CI=2.39, 26.820; std Err. = 0.617; p=0.001] or public health facilities [OR=4.532 CI=1.518, 13.530; std Err. = 0.558; p=0.007], perception of scheme as being open with information [OR=3.375; CI=1.941, 5.866; std Err. = 0.282; p=0.001] and perceived good quality of care in accredited facilities [OR=1.825; CI=1.053, 3.162; std Err. = 0.280; p=0.032]. The researcher found that the enrolment was 35%, below the set target of 100% by 2022. The researcher concluded that socio-economic factors are associated with enrolment, the perception of accountability of NHIF scheme influences enrolment while perception of quality of care influences enrolment with those who perceived quality to be good enrolling more. The researcher recommend that the county government should step up awareness to increase enrolment, the government should come up with strategies to improve income and increase education including implementing policy on basic education and minimum wage and also the health insurance subsidy programs, the NHIF needs to be open with information which the public needs on use of resources and the services covered, county government should ensure good quality of healthcare is maintained in health facilities through regular quality assessments.