Browsing by Author "Abraham, Elisante"

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    Barriers and facilitators to health insurance enrolment among people working in the informal sector in Morogoro, Tanzania
    (AAS Open Research, 2021-09-01) Abraham, Elisante; Gray, Cindy; Fagbamigbe, Adeniyi; Tediosi, Fabrizio; Otesinky, Brianna; Haafkens, Joke; Mhalu, Grace; Mtenga, Sally
    Background: Health insurance is a crucial pathway towards the achievement of universal health coverage. In Tanzania, health-financing reforms are underway to speed up universal health coverage in the informal sector. Despite improved Community Health Fund (iCHF) rollout, iCHF enrolment remains a challenge in the informal sector. This study aimed to explore the perspectives of local women food vendors (LWFV) and Bodaboda (motorcycle taxi) drivers on factors that challenge and facilitate their enrolment in iCHF. Methods: A qualitative study was conducted in Morogoro Municipality through in-depth interviews with LWFV (n=24) and Bodaboda drivers (n=26), and two focus group discussions with LWFV (n=8) and Bodaboda drivers (n=8). Theory of planned behaviour (TPB) constructs (attitude, subjective norms, and perceived control) provided a framework for the study and informed a thematic analysis focusing on the barriers and facilitators of iCHF enrolment. Results: The views of LWFV and Bodaboda drivers on factors that influence iCHF enrolment converged. Three main barriers emerged: lack of knowledge about the iCHF (attitude); negative views from friends and families (subjective norms); and inability to overcome challenges, such as the quality and range of health services available to iCHF members and iCHF not being accepted at non-government facilities (perceived control). A number of facilitators were identified, including opinions that enrolling to iCHF made good financial sense (attitude), encouragement from already-enrolled friends and relatives (subjective norms) and the belief that enrolment payment is affordable (perceived control). Conclusions: Results suggest that positive attitudes supported by perceived control and encouragement from significant others could potentially motivate LWFV and Bodaboda drivers to enroll in iCHF. However, more targeted information about the scheme is needed for individuals in the informal sector. There is also a need to ensure that quality health services are available, including coverage for non-communicable diseases (NCDs), and that non-government facilities accept iCHF.
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    Perceived facilitators and barriers to enrolment in health insurance among people working in the informal sector in Morogoro, Tanzania
    (NM-AIST, 2022-06) Abraham, Elisante
    Health financing is an important pathway towards universal health coverage (UHC). In Tanzania, despite an improved Community Health Fund (iCHF) rollout, people in the informal sector haven’t been fully enrolled. This study explored the perspectives of local-women food vendors (LWFV) and Bodaboda (motorcycle taxi) drivers on factors that facilitate and challenge their enrolment in iCHF. A phenomenological study was conducted in Morogoro Municipality. Fifty in-depth interviews and two focus group discussions were conducted. Participants were purposively selected based on being LWFV or Bodaboda drivers. The Theory of Planned Behaviour (TPB) provided a framework for the inquiry and categorization of findings. Views from LWFV and Bodaboda drivers regarding enrolment in iCHF converged. Enrolment facilitators on attitude: value for money; and increased access to affordable health care. Subjective norms: encouragement from already-enrolled friends and relatives. Perceived control: belief that enrolment premiums are affordable; and improved health care. Barriers on attitude: limited knowledge of how the iCHF works; and no health promotion activities. Subjective norms: negative views from friends and family. Perceived control: the iCHF is not accepted in non-government facilities; limited time to go for enrolment; and uncertainty about coverage of non-communicable diseases. Results suggest that a positive attitude towards iCHF, supported by perceived benefits and encouragement from significant others, can motivate LWFV and Bodaboda drivers to enroll. However, more awareness of iCHF is needed among individuals in the informal sector. There is also a need to make quality health care services available to iCHF members, including extending their coverage.