INFLUENCE OF CULTURE ON HEALTH INSURANCE UPTAKE AMONG PATIENTS AT CHOGORIA MISSION HOSPITAL, THARAKA NITHI COUNTY

Abstract

The government of Kenya plans to largely finance Universal Health Coverage through the National Health Insurance Fund (NHIF). However, most of the Kenyan population do not have health insurance cover. They rely mainly on out-of-pocket payment. The reality today is that uptake of health insurance is still low in general, particularly in rural areas, where the majority of Kenyans live. Studies have identified four main reasons why individuals are not registered for any form of health insurance: affordability, value, relevance and process. However, these reasons may be complicated by cultural and social beliefs, as revealed by studies done in other middle and low- income countries. The aim of this study was to describe cultural beliefs and practices that may have an influence on health insurance uptake. We used a qualitative phenomenology study design over a period of 3 months at Chogoria Mission Hospital. The target population of this study was patients seeking care at Chogoria Mission Hospital. The study used a purposive sampling to recruit participants from inpatient and outpatient departments. Through 20 in-depth interviews using a semi structured design and utilizing the constant comparative method of analysis, we identified the following themes: religious beliefs, patriarchal culture, traditional medicine use, economic priority, misconception of value and procrastination, peer influence of purchasing insurance and Harambe as factors that might have an influence on health insurance uptake. Unique to this study was the theme about health insurance being associated with family and community dissociation or cohesion. Compared to findings in other countries, the findings of this study suggest that culture also has an influence on health insurance. This study suggests that most reasons of non-enrollment are hinged on cultural motivation. The results of this study need to be explored more in details in other studies. The study recommends the following to the stakeholders: Identify and use community champions (religious leaders, local authorities, traditional healers, insured champions) as agents and advocates of health insurance in general but the National Health Insurance, specifically. Clinicians dealing with patient without health insurance should do a quick diagnosis of things that might be hindering patient to have insurance and do an appropriate counseling accordingly.