Knowledge and enrollment in the social health insurance fund: evidence from informal sector workers in Homa Bay County, Kenya

Abstract

Background: Access to affordable healthcare remains a global challenge, with many facing catastrophic out-of-pocket costs. Universal health coverage (UHC) relies on prepayment and risk-pooling schemes like health insurance. In Africa, social health insurance exists in countries like Ghana and Nigeria, but knowledge gaps limit enrollment. Kenya’s 2023 social health insurance fund (SHIF) mandates coverage, yet informal workers show low participation. This study explores knowledge factors influencing SHIF uptake in Homa Bay County.

Methods: The study employed a descriptive cross-sectional design. Using stratified random sampling, 284 respondents were recruited. Data were collected via questionnaires with informed consent. Ethical approval was obtained from KNH/UoN, and permits from NACOSTI. SPSS v26.0 was used for descriptive and Chi-square analyses at a 95% confidence level.

Results: The study found SHIF uptake at 50.4% among informal sector workers in Homa Bay County. Awareness of SHIF benefits was low at 45.8%, while only 40.5% were familiar with the enrollment process. Key factors significantly associated with uptake included knowledge of benefits (p=0.0001), familiarity with enrollment (p=0.0003), sources of information such as healthcare providers and media (p=0.0074), and positive perceptions of SHIF (p=0.0035).

Conclusions: SHIF uptake among informal sector workers was moderate (50.4%), with enrollment significantly influenced by knowledge of benefits, familiarity with the process, information sources, and perceptions. The study recommends enhancing awareness, simplifying enrollment, leveraging trusted communication channels, and promoting positive perceptions to improve coverage and advance progress toward universal health coverage.