Attitude of employees in the informal sector towards the national health insurance strategy in Uganda

Abstract

Access to health care remains a challenge especially among the informal sector in most of the low-income countries due to out of pocket (OOP) expenditures, with Uganda spending over 40% out of pocket on health care. To solve this, Uganda has proposed a National Health Insurance Scheme. This study sought to assess how socioeconomic and demographic factors, knowledge and attitude toward health insurance and the National Health Insurance strategy contribute to the “Attitude of employees in the informal sector towards the National Health Insurance Strategy in Uganda”. The quantitative cross-section study involved the distribution of 83 questionnaires to respondents with in Kawempe district. This study employed judgment sampling which is a type of purposive sampling technique. Univariate, bivariate, multivariate analysis and cross-tabulations were performed on the variables to establish relationships in Stata. The results of the study under bivariate analysis revealed relatively significant relationships between the education level (p-value = 0.002), knowledge of health insurance (p-value=0.014), health insurance is important in protecting my family (p-value=0.002), knowledge of NHIS (value=0.034), affordability of NHIS (p-value=0.001) and worthiness of the NHIS benefits (0.023). In the multivariate analysis, knowledge of health insurance (OR=2.4154) and worthiness of the NHIS benefits (OR=0.1732) were the greatest predictors of the employees’ attitude on whether the government is doing the right thing by introducing the NHIS. In this study, it was found that the most of the respondents representing the general population were knowledgeable about health insurance, however, they were not as knowledgeable about the proposed National Health Insurance Strategy. The strategy was passed in parliament in 2021, however, more advocacy was needed to ensure that the president signs it in a timely manner. There is a need for the advocates to continue engaging with the president to highlight the benefits of the NHIS and also to plan to maintain pressure to sign the bill by continuing media coverage and strategic messaging to create more awareness of the NHIS.