Coping strategies for health care financing among informal sector workers in Dar es Salam, Tanzania

Abstract

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).