Determinants of uptake of Health care insurance among households in Kibera Informal settlement, Nairobi County.

Abstract

Low and Middle-Income Countries have extended Health Insurance to people outside the formal sector to enhance access to healthcare. However, in spite of the relatively low costs of signing up and the benefits offered by the cover, up-take rates are very low among the informal settlements population. The study aimed at establishing determinants of health care insurance uptake among households in Kibera informal settlement, Nairobi County. A cross-sectional study was implemented in 166 systematically sampled households from approximately 2,400 residents‘ from one randomly selected village (Makina) out of the 12 villages within Kibera slum. A semi- structured questionnaire was administered to each household head, data was analyzed by descriptive statistics while figure and tables were utilized to present the results. Standard univariable logistic regression model was utilized to test the association between proportion of health insurance uptake and independent variables. The proportion of respondents who had taken up health insurance in the informal settlement were 27.1% (n=45). Significant relationships (p<0.005) between health insurance enrollment and measured factors (measured as odds ratios (ORs)) were obtained as follows: compared to married respondents (OR=1), single, combined separated &divorced and widowed respondents were 68%, 86%, 62% respectively less likely to own medical insurance. Respondents who had attained post-secondary, secondary and primary education were 11.3 (95% CI, 2.25, 56.59; P=0.014), 2.3 (95% CI, 0.72, 7.3) and 1.6 (95% CI, 0.57, 4.26) times more likely to take up insurance compared to those with no formal education. Respondents working in the informal employment sector were 96% (95% CI, 0.00, 0.32; P=0.0001) were negative significantly associated with health insurance program. About a quarter (n=39, 23.5%) were indebted from health care expenses. In this study there was high distribution of slum residents (73%) with no uptake of health insurance as compared to the health financing strategy scheme 2007 whose coverage was 60-80%. Modifiable socio-economic factors dominated possible reasons for uptake/ non-uptake of health insurance. Thus, measures to improve households socio-economic status are needed in settings such as Kibera informal settlements. Further, there is need for policy makers to design health financing reforms targeting socio-economically vulnerable people within the context of universal health co