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dc.contributor.authorMarenya, Adhiambo S
dc.identifier.citationMasters of Arts in Development Studies, University of Nairobi 2005.en
dc.description.abstractThe 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
dc.publisherUniversity of Nairobi.en
dc.titleFactors influencing membership in Community based health insurance schemes: The case of PCEA Chogoria Hospital Akiba Health Fund in Meru South Districten
local.publisherInstitute for Development studiesen

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