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.
Highlights
The 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
With regard to payments collection, while premiums for those working in the formal sector can be collected through payroll deductions, one of the challenges faced by many African countries in the implementation of social health insurance schemes is how to come up with modalities for collecting contributions from the large proportion of the population working in the informal sector [3]
Descriptive analysis The descriptive analysis demonstrated that a majority of the slum residents (89%) did not have any type of health insurance coverage, while only 10% had enrolled in the NHIF program
Summary
The 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. As the government prepares to re-introduce the NSHIF legislation in parliament, it is important to have a better understanding of factors associated with participation in the current National Hospital Insurance Fund (NHIF), among the poor, as well as a determination of the proportion of individuals without access to health insurance among this demographic group. According to the 2005/06 national health accounts, 36% of funds to the health sector came from households and out of these, the out-of-pocket expenditure accounted for more than 29% [27] These findings raise concern about equity and financial accessibility to health care by a majority of people in Kenya, the poor who are highly vulnerable to economic shocks that result from catastrophic out-of-pocket health expenditure. Extending access to health care to all segments of the population, including the poor is an important objective of the Kenyan government’s national health sector strategic plan and national development agenda as outlined in the Kenya Vision 2030 policy framework [33,34,35]
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