Abstract:
Health insurance, a cornerstone of social protection in healthcare, exhibits varied
implementation and success levels globally. In developed nations, such as those in North
America and Europe, health insurance coverage is often comprehensive, facilitated by robust
national systems and policies (Bawa & Ruchita, 2011). These regions showcase high
awareness and utilization rates, attributing to their longstanding history in health insurance
implementation, as exemplified by Germany's pioneering national social health insurance
system initiated by Chancellor Bismarck in 1883 (Ehrich, et al., 2016). Conversely,
developing countries face distinct challenges. While nations like China, Indonesia, and India
have made strides in extending coverage, they still grapple with limited population coverage
through their social health insurance schemes (WHO, 2003).
In Africa, the health insurance landscape is even more complex. Sub-Saharan Africa, with
just 3% of the global health workforce (Tanmantong, 2010), faces a dire need for health
personnel, which impacts the effectiveness of health insurance systems. The WHO's "treat,
train, retain" initiative in 2008 sought to address this by promoting formal cadres of
Community Health Workers (Sethi and Bhatia, 2009). However, the coverage remains low,
and challenges in service quality and accessibility persist.
Health insurance schemes across Africa, and specifically in Tanzania, face a critical
challenge of low enrollment rates despite the availability of exemptions and subsidies. This
issue is particularly pronounced in Community-Based Health Insurances (CBHIs), which,
despite their potential to reduce out-of-pocket expenses, are plagued by market failures such
as adverse selection and moral hazard, and still demonstrate limited population coverage
(McIntyre et al., 2018). In Tanzania, the National Health Insurance Fund (NHIF) and the
Community Health Fund (CHF) have made strides in increasing membership and
beneficiaries; however, coverage remains insufficient. As of June 2018, only 32% of
Tanzania's population was covered by health insurance, a stark contrast to the nation's needs,
especially in rural areas where the majority of the population resides and where enrollment is
critically low (NHIF, 2018; Luhanga, 2015).
Despite incremental progress in enrollment, there is a significant gap in understanding the
community's level of awareness and attitudes towards health insurance schemes. Research to
date, such as studies by Ogbonna et al. (2012), Appiah et al. (2012), and Mulupi et al. (2013),
provides valuable insights into enrollment figures and the expansion of these schemes.
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However, it falls short in exploring the depth of community awareness, understanding, and
perceptions, especially in rural areas which represent the bulk of Tanzania's population.
This study, therefore, addresses a critical and understudied problem: the disconnect between
the availability of health insurance schemes and their low uptake, particularly in rural regions
of Tanzania. Health insurance is a key tool in mitigating health-related financial burdens and
pooling health risks, but the effectiveness of these schemes is significantly hindered by a lack
of community awareness. With a range of options from community-based programs to
private insurances available, the substantial unawareness of these choices, as noted by
Aderibigbe et al. (2017), poses a major barrier to increasing enrollment rates and achieving
Universal Health Coverage (UHC). This study aims to bridge this knowledge gap by delving
into the levels of community awareness regarding health insurance in Tanzania, thereby
contributing to the broader goal of enhancing health insurance coverage and advancing
towards UHC.
2.0 SUMMARY OF INNOVATIVE FINDINGS
The study aimed to explore the awareness, perception, and the factors influencing health
insurance among community members in Hai District, Kilimanjaro region. The objectives
were structured to evaluate the existing knowledge about health insurance, assess community
perceptions towards its importance, and identify socio-demographic factors influencing
awareness levels.
2.1 Evaluation of Community Members’ Existing Knowledge about Health Insurance.
Findings indicated that a significant proportion of the community (approximately 85%) had a
substantial understanding of health insurance's importance. However, there was a noticeable
gap in knowledge regarding specific preventive care services and the extent of coverage
offered by health insurance plans. This underscores the need for clearer communication and
educational initiatives to enhance understanding of these aspects.
2.2 Assessment of Community Members’ Perception Towards the Importance of Health
Insurance.
The study revealed a generally positive attitude towards health insurance, with a large
majority recognizing its importance for familial well-being (68.4%) and expressing
willingness to enroll (67.4%). Despite this, the satisfaction levels with current health
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insurance policies were mixed, with only 43% expressing full satisfaction. This suggests the
need for policy refinement to address diverse needs and expectations.
2.3 Identification of Socio-Demographic Factors Influencing Awareness Levels. Analysis
highlighted several factors significantly impacting health insurance awareness and
perception. These included employment status, access to financial services, social media
influence, and family member endorsement. In contrast, age, sex, and marital status had
limited impact on health insurance awareness. This finding is critical for targeting future
awareness campaigns and policy interventions to increase enrollment and effective utilization
of health insurance schemes.
3.0 IMMEDIATE APPLICATION OF THE FINDINGS
In conclusion, the study on health insurance awareness, perception, and influencing factors
among community members in Hai District, Kilimanjaro region revealed notable insights.
While a substantial portion of the community demonstrated a commendable understanding of
health insurance's importance, there exists a knowledge gap concerning specific preventive
care services and the extent of coverage provided by insurance plans. The positive overall
attitude towards health insurance, coupled with the willingness to enroll, indicates a favorable
environment for increased participation. However, the mixed satisfaction levels suggest the
necessity for refining policies to better align with diverse expectations. The identification of
socio-demographic factors influencing awareness, such as employment status and access to
financial services, provides valuable information for targeted awareness campaigns and
policy interventions, emphasizing the need for nuanced strategies to enhance health insurance
awareness and enrollment in the community.
4.0 CONCLUSION AND RECOMMENDATIONS
In conclusion, while there is a high level of awareness and a positive perception towards
health insurance in Hai District, gaps in knowledge about specific aspects of health insurance
plans persist. The findings from this study offer valuable insights for policymakers and health
insurance providers to enhance the effectiveness of health insurance schemes by focusing on
targeted awareness initiatives and policy refinement.
Based on the objectives of the study, the following actionable recommendations are proposed
to enhance the awareness and perception of health insurance: Educational Campaigns:
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Launch comprehensive educational initiatives to increase public knowledge about the specific
coverages, preventive services, and the holistic advantages of health insurance. Utilize a
variety of mass media channels, such as radio, magazines, and television, to ensure
widespread reach and engagement. Personalized Communication Strategies: Develop and
implement communication strategies tailored to the unique needs and circumstances of
different community segments. Focus particularly on individuals with limited access to
financial resources, leveraging the influential power of social media and family networks to
boost awareness and positive perceptions.
Policy Transparency: Work diligently to improve the clarity and accessibility of health
insurance policy documents. Ensure that these documents are straightforward and easy to
comprehend, thereby enhancing customer satisfaction, reducing confusion, and fostering trust
in the health insurance system. Youth Engagement: Launch targeted campaigns to highlight
the benefits of obtaining health insurance at an early age. Focus on showcasing the long-term
advantages of early enrollment to encourage proactive participation among the younger
demographic.