Perceived facilitators and barriers to enrolment in health insurance among people working in the informal sector in Morogoro, Tanzania

Abstract

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.