Expanding health insurance scheme in the informal sector in Nigeria: awareness as a potential demand-side tool.
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ABSTRACT:
SUBMITTER: Adewole DA
PROVIDER: S-EPMC5554647 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:Insight into the health risk awareness levels of e-waste workers is important as it may offer opportunities for better e-waste recycling management strategies to reduce the health effects of informal e-waste recycling. Therefore, this study assessed the knowledge, attitude, and practices associated with occupational health risk awareness of e-waste workers compared with a control group (butchers) in the informal sector in Nigeria. A cross-sectional study was used to assess health risk awareness of 279 e-waste workers (repairers and dismantlers) and 221 butchers from the informal sector in three locations in Nigeria in 2015. A questionnaire was used to obtain information on socio-demographic backgrounds, occupational history, knowledge, attitude, and work practices. The data was analysed using Analysis of Variance. The three job designations had significantly different knowledge, attitude, and practice mean scores (p = 0.000), with butchers consistently having the highest mean scores. Only 43% of e-waste workers could mention one or more Personal Protective Equipment needed for their job compared with 70% of the butchers. The health risk awareness level of the e-waste workers was significantly lower compared with their counterparts in the same informal sector. A positive correlation existed between the workers' knowledge and their attitude and practice. Therefore, increasing the workers' knowledge may decrease risky practices.
| S-EPMC5580614 | biostudies-literature
Project description:BackgroundZimbabwe's tax-based healthcare financing model has been characterised by perennial financing deficits and widespread application of user fees and has thus been socially exclusive. The country's urban informal sector population is not spared from these challenges. The study explored the potential demand for National Health Insurance (NHI) among respondents from selected urban informal sector clusters of Harare. The following clusters were targeted: Glenview furniture complex, Harare home industries, Mupedzanhamo flea market, Mbare new wholesale market and Mbare retail market.MethodsA cross-sectional survey was administered to 388 respondents from the selected clusters, and data on the determinants of Willingness to Join (WTJ) and Willingness to Pay (WTP) was gathered. Respondents were recruited via a multi-stage sampling procedure. In the first stage, the five informal sector clusters were purposely selected. The second stage involved a proportional allocation of respondents by cluster size. Finally, based on the stalls allocated by municipal authorities in each area, respondents were selected using systematic sampling. The sampling interval (k) was determined by dividing the total number of allocated stalls in a cluster (N) by the sample size proportionate to that cluster (n). For each cluster, the first stall (respondent) was randomly chosen, and thereafter, a respondent from every 10th stall was selected and interviewed at their workplace. Contingent valuation was adopted to elicit WTP. Logit models and interval regression were applied for the econometric analyses.ResultsA total of 388 respondents participated in the survey. The dominant informal sector activity among the surveyed clusters was the sale of clothing and shoes (39.2%), followed by the sale of agricultural products (27.1%). Concerning employment status, the majority were own-account workers (73.1%). Most of the respondents (84.8%) completed secondary school. On monthly income from informal sector activities, the highest frequency (37.1%) was observed in the Zw$(1000 to <3000) or US$(28.57 to <85.71) category. The mean age of respondents was 36 years. Out of the 388 respondents, 325 (83.8%) were willing to join the proposed NHI scheme. WTJ was influenced by the following factors: health insurance awareness, health insurance perception, membership to a resource-pooling scheme, solidarity with the sick, and household recently experiencing difficulties paying for healthcare. On average, respondents were willing to pay Zw$72.13 (approximately US$2.06) per person per month. The key determinants of WTP were household size, respondent's education level, income, and health insurance perception.ConclusionsSince the majority of respondents from the sampled clusters were willing to join and pay for the contributory NHI scheme, it follows that there is potential to implement the scheme for the urban informal sector workers from the clusters studied. However, some issues require careful consideration. The informal sector workers need to be educated on the concept of risk pooling and the benefits of being members of an NHI scheme. Household size and income are factors that require special attention when deciding on the premiums for the scheme. Moreover, given that price instability hurts financial products such as health insurance, there is a need for ensuring macroeconomic stability.
| S-EPMC10228813 | biostudies-literature
Project description:Background: Kenya has made a policy decision to use contributory health insurance as one of its key pre-payment health financing mechanisms. The National Hospital Insurance Fund (NHIF) is the main health insurer in Kenya. While the NHIF has hitherto focused its efforts on providing health insurance coverage to individuals in the formal sector, it has recently broadened its focus to include individuals in the informal sector. This paper provides an analysis of the perceptions, and experiences of informal sector individuals in Kenya with regard to enrolment with the NHIF. Methods: We collected data through key informant interviews (39) in two purposefully selected counties. Study participants were drawn from healthcare facilities contracted by the NHIF, and current, former, and prospective informal sector members. We analyzed data using a grounded approach. Results: Participants felt that the NHIF provided inadequate information about the registration and membership processes as well as benefit entitlements. There was variable and inconsistent communication by the NHIF. There was also variance between the official benefit package and the actual benefits received by members. The NHIF registration requirements and processes presented an administrative barrier to obtaining membership. The NHIF premium level and contribution mechanism presents a financial barrier to current and prospective members. Healthcare providers discriminated against NHIF members compared to cash-payers or private insurance holders. Conclusions: The NHIF could improve enrolment and retention of informal sector individuals by; 1) using communication strategies that are effective at reaching the informal sector, 2) improving the affordability of the premium rates, 3) simplifying the enrolment requirements and process, and 4) strengthening accountability mechanisms between itself and healthcare facilities to ensure that enrolled members receive the benefits that they are entitled to, and that client experience at healthcare facilities are satisfactory.
| S-EPMC5698913 | biostudies-other
Project description:Lack of credibility and trust in fund managers has been highlighted as one of the key reasons why people do not join health insurance schemes in low- and middle-income countries, especially in Africa. This work investigates the impact of corruption on households' willingness to participate and pay for health insurance in Sierra Leone. A discrete choice experiment (DCE) method was used to elicit households' willingness to participate in a health insurance scheme with different attributes. The data were collected from 1458 representative households working in the informal sector of the Northern and Western regions. We explore the relationship between household characteristics and experienced (respectively, perceived) corruption with binary and ordered logit models. We use a Mixed Logit model to estimate the association between corruption and participation in a Health Insurance Scheme (HIS) and households' willingness to pay for a HIS. We find that corruption decreases participation in a public HIS and the willingness to pay for it. Our results highlight the perverse spillover effects of corruption. Not only does corruption hinder the effectiveness of healthcare systems and, thus, worsen health outcomes. It also undermines the willingness to pay for them, jeopardizing the sustainability of healthcare systems in the countries that need them most.
| S-EPMC10101380 | biostudies-literature
Project description:PurposeThe objective of this project is to study the willingness to pay (WTP) for health insurance (HI) of individuals working in the informal sector in Sierra Leone, using a purposely-designed survey of a representative sample of this sector.MethodsWe elicit the WTP using the Double-Bounded Dichotomous Choice with Follow Up method. We also examine the factors that are positively and negatively associated with the likelihood of the respondents to answer affirmatively to joining a HI scheme and to paying three different possible premiums, to join the HI scheme. We additionally analyze the individual and household characteristics associated with the maximum amount the household is willing to pay to join the HI scheme.ResultsThe results indicate that the average WTP for the HI is 20,237.16 SLL (3.6 USD) per adult but it ranges from about 14,000 SLL (2.5 USD) to about 35,000 SLL (6.2 USD) depending on region, occupation, household and respondent characteristics. The analysis of the maximum WTP indicates that living outside the Western region and working in farming instead of petty trade are associated with a decrease in the maximum premium respondents are WTP for the HI scheme. Instead, the maximum WTP is positively associated to being a driver or a biker; having secondary or tertiary education (as opposed to not having any); the number of pregnant women in the household; having a TV; and, having paid for the last medical requirement.ConclusionsIn summary, the various analyses show that a premium for the HI package could be set at approximately 20,000 SLL (3.54 USD) but also that establishing a single premium for all individuals in the informal sector could be risky. The efficient functioning of a HI scheme relies on covering as much of the population as possible, in order to spread risks and make the scheme viable. The impact of the various population characteristics raises the issue of how to rate premiums. In other words, setting a premium that may be too high for a big proportion of the population could mean losing many potential enrollees and might have viability consequences for the operation of the scheme.
| S-EPMC5955490 | biostudies-literature
Project description:This study was aimed at investigating the effect of internal and external social capital on the financial and non-financial performance of businesses in the Nigerian informal sector. The study further investigated the controlling role of firm age. A cross-sectional survey of 650 informal business owners in the Ikeja region of Lagos state, Nigeria was carried out. The analysis was carried out using the partial least square method of the structural equation model (SEM). Findings revealed that without the controlling variable of firm age, social capital had a significant effect on business performance, internal social capital had a significant effect on non-financial performance, it, however, had no significant effect on financial performance, while external social capital had no significant effect on financial and non-financial performance. With the controlling variable of firm age, social capital had a significant effect on business performance, internal social capital had a significant effect on financial and non-financial performance, while external social capital had no significant effect on financial and non-performance. The study, therefore, recommended that informal entrepreneurs take advantage of their internal social capital resources and also try to build their external social capital as they may become vital for their business success.
| S-EPMC6661269 | biostudies-literature
Project description:Providing access to affordable health care for the informal sector remains a considerable challenge for low income countries striving to make progress towards universal health coverage. The objective of the study is to identify the factors shaping the decision to enroll in a cooperative based health scheme for informal workers in Bangladesh and also help to identify the features of informal workers without health schemes and their likelihood of being insured.Data were derived from a cross-sectional in-house survey within the catchment area of a cooperative based health scheme in Bangladesh during April-June 2014, covering a total of 784 households (458 members and 326 non-members). Multivariate logistic regression model was used to identify factors associated with cooperative based health scheme and explanatory variables.This study found that a number of factors were significant determinants of health scheme participation including sex of household head, household composition, occupational category as well as involvement social financial safety net programs.Findings from this study can be suggestive for policy-makers interested in scaling up health insurance for informal workers in Bangladesh. Shared funding from this large informal sector can generate new resources for healthcare, which is in line with the healthcare financing strategy of Bangladesh as well as the recommendation of the World Health Organization for developing social health insurance as part of the path to Universal Health Coverage.
| S-EPMC5531431 | biostudies-other
Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had large negative effects on countries' economies and individual well-being throughout the world, particularly in low- and middle-income countries. Pandemic-related changes in behavior and government restrictions in Kenya may have negatively affected food supply chains and household food access; however, the empirical evidence is currently limited.ObjectivesThe study explored changes in informal milk markets, dairy consumption, and food insecurity among low-income households in urban and periurban Nairobi, Kenya, following the start of the COVID-19 pandemic in the country.MethodsBaseline data on milk sales and consumption were collected in late 2019 from dairy vendors operating in the informal sector and their dairy customers. We conducted 2 longitudinal telephone surveys with the same study participants in July and September-October 2020, respectively.ResultsAt the first follow-up, the volume of milk sold by informal vendors had dropped by 30% compared with their baseline level, and the volume of milk from informal markets consumed by households decreased by 23%. By the second follow-up, the volume of milk sold and consumed had recovered somewhat but remained lower than the volume observed 1 y prior in the same season. Large reductions in the consumption of other animal-sourced products were also observed. The rate of food insecurity increased by 16 and 11 percentage points in the first and second follow-up periods, respectively, compared with baseline.ConclusionsThe evidence, therefore, suggests that the timing of the pandemic and the related restrictions were associated with a decrease in the supply and consumption of milk from informal markets in Nairobi and a decrease in the food security of periurban consumers.
| S-EPMC9957657 | biostudies-literature
Project description:One of the main challenges facing the expansion of universal health coverage (UHC) in developing countries like Indonesia is the high prevalence of those working in the informal sector who must voluntarily register in the National Health Insurance System (NHIS). This condition hinders some from being covered by the NHIS. Following Bourdieu's concepts of field, capital and habitus, this research aims to analyse some aspects that influence the decision of informal sector workers to join the NHIS in Indonesia. We conducted qualitative methods, including in-depth interviews of 29 informants and Focus Group Discussion (FGD) in the three selected regions of Deli Serdang (North Sumatera), Pandeglang (Banten) and Kupang (East Nusa Tenggara). Using thematic content analysis and several triangulation processes, this study found that three main factors influence the decisions of those working in the informal sector to join the NHIS: health conditions, family and peers, and existing knowledge and experience. The stories provided by the informants regarding their decision-making processes in joining NHIS also reveal the necessary and sufficient conditions that enable informal sector workers to join the NHIS, which are individual-specific and which may differ between people, depending on individual characteristics, regional socioeconomic and demographic characteristics and belief systems. These three factors are all necessary conditions to support the joining of informal sector workers into the NHIS. This study suggests that one possible route for expanding the UHC coverage of informal sector workers is through maximising the word-of-mouth effect by engaging local or influential leaders.
| S-EPMC7609471 | biostudies-literature
Project description:BackgroundResponsiveness of health care services in low and middle income countries has been given little attention. Despite being introduced over a decade ago in many developing countries, national health insurance schemes have yet to be evaluated in terms of responsiveness of health care services. Although this responsiveness has been evaluated in many developed countries, it has rarely been done in developing countries. The concept of responsiveness is multi-dimensional and can be measured across various domains including prompt attention, dignity, communication, autonomy, choice of provider, quality of facilities, confidentiality and access to family support. This study examines the insured users' perspectives of their health care services' responsiveness.MethodsThis retrospective, cross-sectional survey took place between October 2010 and March 2011. The study used a modified out-patient questionnaire from a responsiveness survey designed by the World Health Organization (WHO). Seven hundred and ninety six (796) enrolees, insured for more than one year in Kaduna State-Nigeria, were interviewed. Generalized ordered logistic regression was used to identify factors that influenced the users' perspectives on responsiveness to health services and quantify their effects.ResultsCommunication (55.4%), dignity (54.1%), and quality of facilities (52.0%) were rated as "extremely important" responsiveness domains. Users were particularly contented with quality of facilities (42.8%), dignity (42.3%), and choice of provider (40.7%). Enrolees indicated lower contentment on all other domains. Type of facility, gender, referral, duration of enrolment, educational status, income level, and type of marital status were most related with responsiveness domains.ConclusionsAssessing the responsiveness of health care services within the NHIS is valuable in investigating the scheme's implementation. The domains of autonomy, communication and prompt attention were identified as priority areas for action to improve this responsiveness. For the Nigerian context, we suggest that health care providers in the NHIS should pay attention to these domains, and the associated characteristics of users, when delivering health care services to their clients. Policy makers, and the insurance regulatory agency, should consider the reform strategies of monitoring and quality assurance which focus on the domains of responsiveness to lessen the gap between users' expectations and their experiences with health services.
| S-EPMC4220628 | biostudies-literature