Factors affecting enrollment in social health insurance benefit: a case of employees’ perspective in Dar es Salaam.

Abstract

Background; In 2001 the government of Tanzania initiated health care financing reforms, one of it was the Social Health Insurance schemes targeting to improve access to health care services, quality of health services and protect people against financial catastrophic expenditures. Since SHIB inception there were scanty specific studies that explored why the enrolment to the scheme has not been substantially rising. Objectives; The aim of this study was therefore to explore factors affecting enrollment in the Social Health Insurance Benefit among National Social Security Fund members in Dar es Salaam through assessment of their risk profile, risks perceptions regarding enrolment, awareness level of health insurance and the quality of health care services. Methodology; This study was conducted in Dar-es-Salaam region involving employees from both public and private organizations who are NSSF members. The study employed random and multistage sampling technique to obtain a required sample. Primary data for the study were collected by using closed and open ended semi-structured self-administered questionnaire to elicit information corresponding to study specific. Data were analysed using Statistical Package for Social Science -SPSS Version 21. Findings; A total of 327 NSSF members participated in the study, 241 (73.70%) were males and 86 were females (26.30%). Non SHIB members were 225 (68.8%) and SHIB members were 102 (31.2%). The level of awareness on SHIB decreases with the decrease level of education among non SHIB members. Furthermore 27 (79.4%) of males and 7(20.6%) of females participants strongly disagree that the accredited health care facilities provide adequate supply of medicines. The results shows high percentages of participants 31.85% those who heard about health insurance and 41.11% those not heard about health insurance feared that their contributions will be deducted to cover SHIB medical bills. Other reasons were, no enough time to accomplish registration procedures, difficult procedures of enrollment, associated registration cost during registration were almost having average of (20%) amongst participants. Conclusion Since NSSF registration and SHIB enrollment are separately done and SHIB enrollment is voluntary, a careful review of SHIB code is required to address the enrollment gap. However, well designed SHIB demand creation of community campaigns, sanitations and educations initiatives are worth investing to promote SHIB enrollment which largely contributes not only to promote health of the NSSF members but also reducing income poverty. Recommendations The study recommends to the NSSF governing body to review its SHIB code, so that enrollment procedures are not separated with the NSSF registration. Extensive community sensitization should done focusing to inform the mass that their monthly contribution will not be deducted in case they become SHIB members. Work place registration is a good strategy to increase enrollment because most employees have no enough time to go for the SHIB registration.