Health insurance for informal workers: What is hindering uptake? Perspectives from female food vendors in Kinondoni District, Tanzania

Abstract

Background

Health insurance among people of low income, such as female food vendors and others in the informal sector, is one of the vital steps towards universal health coverage in Tanzania. Little is known to explain reasons for low enrolment of informal workers in health insurance schemes. We studied what is hindering uptake of health insurance among female food vendors in Kinondoni district in Dar es Salaam.

Methods

The study took place from January to March 2018. A mixed methods design was employed using a quantitative questionnaire and qualitative interviews. We included 75 respondents of which 70 were female food vendors selected using the snow-balling method. Five respondents were officials from the National Health Insurance Fund, who were purposefully selected.

Results

Almost half of respondents (45.7%) were earning less than TZS 100,000 (equivalent to US $44.80) a month. Most (82.9%) could not afford health insurance. Attitudes did not affect uptake of health insurance as the majority (60.0%) agreed that health insurance is vital for their survival. However, a majority (63.4%) of respondents did not know how health insurance works.

Conclusion

The low level of income and limited awareness of health insurance options limited enrolment into health insurance. Interventions should ensure that everyone is enrolled irrespective of economic status. Moreover, the government should design innovative strategies to increase awareness about health insurance.