Drivers of Health Insurance Coverage in Low Income Settlements: A Case of Kibera Informal Settlement, Nairobi County, Kenya
Keywords:
Health insurance, Low-income populations, Kibera, Informal settlements, Kenya
Abstract
Insurance is critical for any country's economic growth and development to be sustainable. In rural areas of Kenya, among the illiterate, unemployed, poor, and vulnerable in society, health insurance adoption is extremely low. This paper focuses on determining the drivers for health insurance uptake among low-income populations in Kibera, Nairobi County. Semi structured questionnaires were administered to households located in Kibera informal settlements to collect data. The Yamane (1967) formula was used to select the sample size. Simple random sampling was adopted in selecting 399 respondents. Both descriptive and inferential analysis were conducted. The binary probit regression model was employed. Health insurance ownership was used as the dependent variable while age, gender, marital status, household size, school attainment, occupation, income levels, religion, cultural beliefs, frequency of hospital visits, cost of premiums, and pre-existing illness were used as the independent variables. Findings revealed that only 27.6 percent of the respondents had health insurance coverage. The findings further revealed that occupation, income levels, and religion significantly influence health insurance ownership among low-income populations in Kibera, Nairobi. Public health insurance cover was the most owned type of health insurance scheme. Recommendations were highlighted for the ministry of health and other relevant stakeholders to raise knowledge on the various health insurance options available and improve flexibility of the products to drive insurance uptake. In addition, national and county governments need to develop programmes and policies that could empower households in the informal settlements. Further, it is necessary for the government to subsidise the cost of acquiring public health insurance covers since this would encourage uptake among low-income families. The ministry of health should also work in conjunction with various religious denominations to campaign for uptake of health insurance among the poor.
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References
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30. Njogu, D. M. (2019). Factors Influencing Health Insurance Uptake In Nyeri County (Doctoral dissertation, University of Nairobi).
31. Nyaboga, J. M. (2019). Effects of Socio-economic Factors on the Uptake of Health Insurance by Motorcycle Taxi Operators in Machakos County, Kenya (Doctoral dissertation, University of Nairobi).
32. Omollo, J. (2016). Factors Contributing to Low Insurance Penetration in Kenya. International Journal of Social Sciences and Entrepreneurship, Vol.1, Issue 2, 2013, 1(2), 463-469.
33. Ozawa, S., Grewal, S., & Bridges, J. F. (2016). Household size and the decision to purchase health insurance in Cambodia: results of a discrete-choice experiment with scale adjustment. . Applied health economics and health policy, 14(2), 195-204.
34. Panda, P., Chakraborty, A., & Dror, D. M. (2015). Building awareness to health insurance among the target population of community‐based health insurance schemes in rural India. . Tropical Medicine & International Health, 20(8), 1093-1107.
35. Saiti, N., Yitambe, A., & Korir, J. (2020). Demand For Health Insurance Among The Elderly In Nairobi City County, Kenya. International Journal of Innovative Research and Advanced Studies, Volume 7 Issue 7, July 2020.
36. Shajahan, S. (2009). Research Methods for Management (3 ed.). . Ahamedabad: Jaico Publishing House.
37. Statista (2019). Insurance industry in Africa- Statistics & Facts. Retrieved from Statista: https://www.statista.com/topics/4206/insurance-industry-in-africa/
38. Van Der Wielen, N., Falkingham, J., & Channon, A. A. (2018). Determinants of National Health Insurance enrolment in Ghana across the life course: Are the results consistent between surveys?. International journal for equity in health, 17(1), 49.
39. World Health Organization (2016). The World Health Report 2015: Research for Universal Coverage. Luxembourg: World Health Organization.
40. World Health Organization (2020). Sustainable Development Goal 3: Health. . Retrieved from World Health Organization: //www.who.int/topics/sustainable-development-goals/targets/en/
41. Yamane, T. (1967). Elementary Sampling Theory. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.
42. Yaya, S. (2020). Wealth status, health insurance, and maternal health care utilization in Africa: evidence from Gabon. BioMed research international, 2020.
43. Yusuf, H. O., Kanma-Okafor, O. J., Ladi-Akinyemi, T. W., Eze, U. T., Egwuonwu, C. C., & Osibogun, A. O. (2019). Health insurance knowledge, attitude and the uptake of community-based health insurance scheme among residents of a suburb in Lagos, Nigeria. West Afr J Med, 36(2), 103-111.
44. Zollmann, J. & Ravishankar, N. (2016). Struggling to thrive: How Kenya’s low-income families (try to) pay for healthcare. Nairobi: FSD Kenya.
2. Alesane, A. & Anang, B. T. (2018). Uptake of health insurance by the rural poor in Ghana: determinants and implications for policy. The Pan African Medical Journal, 31.
3. Andersen, R. (1968). Healthcare service model: explaining factors determining accessibility to healthcare utilization. Journal of health social behaviour, 30 (4).
4. Andersen, R. (1995). Revisiting the behavioural model and access to medical care: does it matter? . Journal of Health Social Behaviour, 36 (1): 1–10.
5. Andersen, R. & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the United States. . Milbank Mem Fund Q Health Society, 51 (1).
6. Barasa, E. W., Mwaura, N., Rogo, K., & Andrawes, L. (2017). Extending voluntary health insurance to the informal sector: experiences and expectations of the informal sector in Kenya. Wellcome open research, 2.
7. Barasa, E., Nguhiu, P., & McIntyre, D. (2018). Measuring Progress towards Sustainable Development Goal 3.8 on Universal Health Coverage in Kenya. . BMJ Global Health , 3(3), 1–13.
8. Barasa, K. (2016). To identify a framework for adoption by insurance industry for enhancing insurance penetration. . Strathmore Business School.
9. Creswell, J. (2014). Research design. International student edition (4th ed). . Los Angeles: SAGE Publication, Inc.
10. Dayour, F., Adongo, C. A., & Kimbu, A. N. (2020). Insurance uptake among small and medium-sized tourism and hospitality enterprises in a resource-scarce environment. Tourism management perspectives, 34, 100674.
11. Dror, D. M., Hossain, S. S., Majumdar, A., Pérez Koehlmoos, T. L., John, D., & Panda, P. K. (2016). What factors affect voluntary uptake of community-based health insurance schemes in low-and middle-income countries? A systematic review and meta-analysis. PLoS One, 11(8), e0160479.
12. Fadlallah, R., El-Jardali, F., Hemadi, N., Morsi, R., Samra, C. A., & Ahmad, A. (2018). Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low-and middle-income countries. International journal for equity in health, 17(1), 13.
13. Ghimire, P., Sapkota, V. P., & Poudyal, A. K. (2019). Factors associated with enrolment of households in Nepal’s national health insurance program. International Journal of Health Policy and Management, 8(11), 636.
14. Gitau, P. (2016). An Assessment of Cultural Factors Affecting Insurance Uptake: A Survey of the Nairobi Central Business Districts. European Journal of Business and Strategic Management, Volume 1, Issue 1, Number 1, 70-87.
15. Hassan, M. A., Mwaura-Tenambergen, W., & Eunice, M. M. (2017). Uptake of health insurance among Muslims in Nairobi county, Kenya. . Pan African Medical Journal, 28(1).
16. Jattani, D. & Ochieng, O. (2021). Can People Afford to Pay Out of Pocket for Health Care in Kenya? https://ieakenya.or.ke/blog/can-people-afford-to-pay-out-of-pocket-for-health-care-in-kenya/
17. Kenya Demographic and Health Survey (2022). Key Indicators Report. KDHS. https://dhsprogram.com/pubs/pdf/PR143/PR143.pdf
18. Kenya National Bureau Of Statistics (2013). Kenya Household Expenditure And Utilization Survey. KNBS. https://statistics.knbs.or.ke/nada/index.php/catalog/56.
19. Kituku, A. M. & Amata, E. (2016). Determinants of the uptake of NHIF medical cover by informal sector workers: a case of UNAITASSACCO members in Murang’a County. . Journal of Public Policy and Administration, 1(1), 17-31.
20. Maina, J. M., Kithuka, P., & Tororei, S. (2016). Perceptions and uptake of health insurance for maternal care in rural Kenya: a cross sectional study. Pan African medical journal, 23(1).
21. Masengeli, N. L., Mwaura-Tenambergen, W., Mutai, J., & Simiyu, B. W. (2017). Determinants of uptake of health insurance cover among Adult patients attending Bungoma County Referral Hospital. . International Journal of Health Economics and Policy, 2(4), 145-1.
22. Ministry of Health (2019). UHC QI Policy Brief. Retrieved from Ministry of Health: https://www.health.go.ke/wp-content/uploads/2019/01/UHC-QI-Policy-Brief.pdf
23. Mohamed, A. A. (2019). Determinants of Uptake of National Hospital Insurance Fund by Self-employed Persons in Kenya: Case of Health Projects in Wajir County, Kenya. Doctoral dissertation, University of Nairobi.
24. Mukangendo, M., Nzayirambaho, M., Hitimana, R., & Yamuragiye, A. (2018). Factors contributing to low adherence to community-based health insurance in Rural Nyanza District, Southern Rwanda. Journal of environmental and public health, 2018.
25. Muketha, D. M. (2016). Determinants Of The Uptake Of National Health Insurance Among Informal Sector Workers In Kenya (Doctoral dissertation, University of Nairobi).
26. Namuhisa, J. A. (2014). Determinants of uptake of National Hospital Insurance Fund scheme by the informal sector in Nairobi county, Kenya. Unpublished MBA Project, Kenyatta University, Kenya..
27. Ndungu, T. T. (2015). Factors influencing uptake of national health insurance in the informal sector: a case of ithanga division in murang’a county, Kenya (Doctoral dissertation, University of Nairobi).
28. Nguru, C. N., Kodhiambo, M. O., & Yitambe, A. (2018). Uptake of Health Insurance among Patients Attending Public and Private Hospitals in Embu County, Kenya. International Journal of Innovative research and Studies, 8.
29. Niyinyumva, B. (2019). Influence of Culture on Health Insurance Uptake Among Patients at Chogoria Mission Hospital, Tharaka Nithi County (Doctoral dissertation, Kabarak University).
30. Njogu, D. M. (2019). Factors Influencing Health Insurance Uptake In Nyeri County (Doctoral dissertation, University of Nairobi).
31. Nyaboga, J. M. (2019). Effects of Socio-economic Factors on the Uptake of Health Insurance by Motorcycle Taxi Operators in Machakos County, Kenya (Doctoral dissertation, University of Nairobi).
32. Omollo, J. (2016). Factors Contributing to Low Insurance Penetration in Kenya. International Journal of Social Sciences and Entrepreneurship, Vol.1, Issue 2, 2013, 1(2), 463-469.
33. Ozawa, S., Grewal, S., & Bridges, J. F. (2016). Household size and the decision to purchase health insurance in Cambodia: results of a discrete-choice experiment with scale adjustment. . Applied health economics and health policy, 14(2), 195-204.
34. Panda, P., Chakraborty, A., & Dror, D. M. (2015). Building awareness to health insurance among the target population of community‐based health insurance schemes in rural India. . Tropical Medicine & International Health, 20(8), 1093-1107.
35. Saiti, N., Yitambe, A., & Korir, J. (2020). Demand For Health Insurance Among The Elderly In Nairobi City County, Kenya. International Journal of Innovative Research and Advanced Studies, Volume 7 Issue 7, July 2020.
36. Shajahan, S. (2009). Research Methods for Management (3 ed.). . Ahamedabad: Jaico Publishing House.
37. Statista (2019). Insurance industry in Africa- Statistics & Facts. Retrieved from Statista: https://www.statista.com/topics/4206/insurance-industry-in-africa/
38. Van Der Wielen, N., Falkingham, J., & Channon, A. A. (2018). Determinants of National Health Insurance enrolment in Ghana across the life course: Are the results consistent between surveys?. International journal for equity in health, 17(1), 49.
39. World Health Organization (2016). The World Health Report 2015: Research for Universal Coverage. Luxembourg: World Health Organization.
40. World Health Organization (2020). Sustainable Development Goal 3: Health. . Retrieved from World Health Organization: //www.who.int/topics/sustainable-development-goals/targets/en/
41. Yamane, T. (1967). Elementary Sampling Theory. Englewood Cliffs, New Jersey: Prentice-Hall, Inc.
42. Yaya, S. (2020). Wealth status, health insurance, and maternal health care utilization in Africa: evidence from Gabon. BioMed research international, 2020.
43. Yusuf, H. O., Kanma-Okafor, O. J., Ladi-Akinyemi, T. W., Eze, U. T., Egwuonwu, C. C., & Osibogun, A. O. (2019). Health insurance knowledge, attitude and the uptake of community-based health insurance scheme among residents of a suburb in Lagos, Nigeria. West Afr J Med, 36(2), 103-111.
44. Zollmann, J. & Ravishankar, N. (2016). Struggling to thrive: How Kenya’s low-income families (try to) pay for healthcare. Nairobi: FSD Kenya.
Published
2023-06-30
How to Cite
Ng’ang’a, E. W., & Odhiambo, M. O. (2023). Drivers of Health Insurance Coverage in Low Income Settlements: A Case of Kibera Informal Settlement, Nairobi County, Kenya. European Scientific Journal, ESJ, 19(18), 94. https://doi.org/10.19044/esj.2023.v19n18p94
Section
ESJ Natural/Life/Medical Sciences
Copyright (c) 2023 Emmah Wanjiku Ng’ang’a, Martine Oleche Odhiambo
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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