| dc.description.abstract | The introduction of user fees in health facilities in the 1980's led to increased cost of
health care reducing health care access to populations. This resulted in deterioration of
quality and quantity of health care and consequently poor health outcomes. To address
this problem health insurance was advanced as a viable payment option that would ensure
health care accessibility and affordability for all even the low-income earners. In Africa,
however, existing public and private insurance mainly cover urban formal workers
locking out informal workers and rural populations. As a response to this voluntary nonprofit
community based health insurance schemes have emerged. Much is however not
known about the nature of participation in such schemes and the factors influencing
membership. This study focuses on one such scheme, the PCEA Akiba Health Insurance
Scheme and attempts to identify factors influencing membership and its inclusiveness.
The study used both primary and secondary data to meet its objectives. To guide the
study and identify key variables for testing in the field, theoretical and empirical
propositions on the subject were reviewed. This formed the basis for methodology used
in the study, which was triangulation between quantitative and qualitative methodology
for more comprehensive results. This involved a survey of members and non-members of
the Akiba scheme and in depth interview of key informants.
The study findings revealed that membership in such schemes was influenced by several
factors. Firstly, social and economic variables, such as household size, income levels and
level of awareness were major considerations when choosing to purchase insurance. Due
to the payment system which is per individual small sized households were more likely to
enrol than bigger households as they paid less premium. Other factors considered
included individual gains in the forms of expected economic, social and security gains.
Probable members weighed these gains against other options and purchased insurance
only when they felt expected benefits would outweigh other options confirming the
strength of rational choice theory in guiding membership .
Secondly, in this study social cohesion manifested by belonging groups and cooperatives
did not translate to increased enrolment unlike studies conducted in other
regions. There seemed to be no clear linkage in the groups' objectives and health
component with most community members perceiving health issues as individual and not
common goods that require mutual assistance. However this study was limited to very
few groups hence there is need for a more comprehensive study to determine this
phenomenon.
Thirdly, while it emerged that the scheme was inclusive incorporating members of varied
ages, marital status, levels of education and even income it was evident that those with
better income especially middle-income levels had a higher chance of being members.
The poorer segments of the society were excluded from the scheme.
Recognising major barriers of membership to be price of premium and lack of awareness
on the scheme, the study recommended adoption of an integrated livelihood approach to
improve rural incomes and more publicity on importance and advantages of insurance
over other forms of payment respectively. In addition it was essential to improve
institutional capacity of health providers to ensure quality services and value for money. | en |
