Adoption of community based health insurance in Luwero District

Abstract

Community-based health-insurance schemes are being advanced as a means to reduce and stabilize the costs of treatment, increase access to health care and to reduce the use of costly risk-coping strategies in the informal sector. The purpose of this study was to examine the adoption of Community Based health insurance in the informal sector in Uganda. Using a case study of Muno Mubulwade Union of Schemes in Luwero district, the study adopted a cross-sectional descriptive research design where both qualitative and quantitative research methods were applied. Data was collected through a survey involving 138 household respondents, 12 key informants and four focus group discussions as well as review of relevant secondary data sources. Thematic and content analysis were undertaken, independent t-test, descriptive statistics and chi-square were used for quantitative data. The findings indicate that the rate of adoption of CBHI is still low (13%). The factors that contributed to the low enrolment are; high premium and inadequate information, large family size and lack of trust in the current schemes. The strategies for addressing the challenges faced in the adoption of CBHI included; the need for flexibility in timing of recruitment of new members and premium collection, involvement of more community members in the scheme development and implementation and a need for massive awareness and information campaigns at the community level. The results show that; CBHI schemes have got the potential to enrol people from different socioeconomic groups, contributing to equity in access to health care. There is also significant positive relationship between the level of education of the household head and enrolment in CHBI schemes, with more primary level household heads among non- members (59.3) than among members (40.7%). This case study indicates that rate of adoption of CBHI, amongst the community members in Luwero is modest, it is still moderately young and would need more time to develop. Among others, the study recommends a closer integration of the informal and formal sectors through establishing national health insurance scheme, which acts as the umbrella with collective involvement of beneficiaries in scheme design and management.