Factors Influencing the Uptake of Health Insurance Schemes Among Low Income Earners in Kibera Informal Settlement, Nairobi City County

Abstract

The main objective of this study was to examine the factors that influence the uptake of health insurance through the National Health Insurance Fund (NHIF) scheme by government among low income earners in Kibera slum, Nairobi City County. More specifically, the study sought to find out health insurance schemes available for uptake among Kibera residents, factors influencing voluntary uptake of NHIF among the Kibera residents and measures necessary to enhance access/uptake of NHIF among the Kibera residents. The methodology involved of purposive sampling of 3 villages out of the 12 villages in Kibera. This was mainly informed by security concerns in selecting 3 villages. Stratified sampling was then done on the three villages to obtain a sample of 125 households. Purposive sampling was then done to obtain key informants who comprised 1 NHIF official in charge marketing for the informal sector, 2 health facility administrators from Mbagathi District Hospital and Kenyatta National Hospital and 1 person from the CIC Insurance Company. Therefore, the total number of Key informants was 4. The study found out that there was low uptake of NHIF cover among most of the respondents. This was hampered by low levels of knowledge about not only NHIF but also of other health insurance schemes available for low income earners. Among the few who were members of NHIF, most had their premiums payed by check off system through their employers. Only few among the NHIF members made payments directly for themselves through either cash or M-pesa payments. Default rates on monthly premiums for those who paid for themselves posed a big challenge in accessing health care since services could not be provided to them if they had arrears on their premiums. Given that most respondents were not on formal employment, they depended either on their daily or weekly wages to make payments for their premiums. The xiii irregular flow of this income was therefore a challenge for them to maintain their membership of NHIF. In order to improve uptake of NHIF cover among low income earners, there is need for increased knowledge and awareness of NHIF among the citizens. More innovative approaches need to be developed for more and more people to get to know about availability of this fund and the amount of premiums payable. NHIF offices also need to be made available at the grass roots level where they can be easily accessed. There needs to be a policy to regulate employers who engage casual labourers to accord their employees NHIF cover as this is not currently in place and many casual labourers do not enjoy NHIF benefits.