Accessibility of Health Insurance among Informal Sector Workers in Dar es Salaam Tanzania: What Are the Barriers?

Abstract

Background World Health Organization’s agenda on Universal Health Coverage (UHC) calls for a protected accessibility to health services. Globally, 1.3 billion people lack access to health services and around 61% are on informal employment. The informal employment exposes individuals to more risks that increase the demand for access to health care services. Health insurance enables households to access health services while being protected against catastrophic health care expenditures. Challenges in accessing health insurance hampered the uptake to health insurance and this has led to an increased morbidity, mortality and catastrophic health care expenditures.

Objective: This study examines the barriers to accessibility of health insurance among the informal sector workers. Methods: A cross-sectional study was performed from September to December 2020 to 889 informal sector workers. Data was collected by using questionnaire, multi-stage sampling technique was used and the respondents were randomly selected from 12 streets. Chi-square test and multivariate logistic regression were used for analysis through the use of Statistical Package for Social Sciences (SPSS) version 23.

Results: Most of the respondents were uninsured (91.1%), more than half (63.6%) were male and the mean age of most respondents was 34.8 years (SD ± 10.4). The barriers to accessibility of health insurance are mistrust of insurance schemes, inadequate information about health insurance, and inaccessibility of health insurance offices and unaffordability of insurance premiums.

Conclusion: Barriers to accessibility of health insurance are practical and they require policy intervention. Subsidized insurance programmes and improvement of mobile based insurance and improved strategies on information dissemination on insurance information will facilitate access and hence improve uptake.