Abstract
Financing health care continues to be a major challenge in low-income countries where universal health coverage is still far from being achieved. The objective of our study is to assess the level of adherence of populations to mutual health insurance and to study the determining factors. We conducted a cross-sectional, descriptive and analytical study among a sample of household heads selected through a two-stage cluster survey from 21 to 31 December 2015 in the district of Guediawaye. A questionnaire validated after a pre-test was administered during an individual interview. Socio-economic and household characteristics, factors related to the provision of care and those related to mutual health insurance were collected. These data were entered and analyzed on Epi Info 2000 version 3.5.3. The significance value was p<0.05. The Odds ratio was used to measure the strength of the link. The study covered 300 heads of household, 90% of whom live in rural areas. The average age was 49.7 years with 93% of male. The overall membership rate was 16.7%. The analysis showed that UDAM membership was influenced by gender with p=0.033 and OR=2.74 (95% CI: 1.04-7.19). There was also a significant relationship between education level and membership of mutual health insurance with p=0.001 and OR=3.71 (95% CI: 1.97-6.99). In the service offer, the quality of the medical prescription encouraged some people to join mutual health insurance with p=0.020 and OR=2.12 (95% CI: 1.12-4). Among the factors related to mutual health insurance, access to information about the existence of mutual health insurance influenced membership with p=0.001 and OR=22.22 (95% CI: 3.01-163.84). This study not only revealed the low level of adherence to mutual health insurance in the Guediawaye health district, but also it helped identify the factors that positively or negatively influence adherence to mutual health insurance. With the involvement of all the actors concerned, such an information should make it possible to improve universal health coverage in the Guediawaye health district.
Highlights
Financing health care continues to be a major challenge in the developing world
The general objective of this study is to analyze the determinants of mutual health insurance membership in the Guédiawaye health district
The study shows that gender, level of education, occupation, marital status, membership of an association, income, appreciation of welcoming conditions, appreciation of drug prescription, access to information on the existence of a mutual health insurance and the fact of having another health insurance were associated with membership of a mutual health insurance
Summary
Financing health care continues to be a major challenge in the developing world. Despite efforts to improve the delivery of health services, many low-and middle-income countries are still far from achieving universal health coverage [9]. In Africa, analyses of health reforms in recent decades all lead to the same conclusion: the equity aspect of public health policies has been neglected, and the primary concerns of the actors have focused on the effectiveness of the organization to be put in place [2, 12]. These policies (primary health care with Alma-Ata in 1978; cost recovery in the Bamako Initiative in 1987) have generalized the pricing of medical procedures and the sale of drugs, from basic care to hospital care. In the absence of health insurance or effective care for
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