TY  - BOOK
AU  - 
AU  - 
AU  - 
TI  - Knowledge, Attitudes, Expectations, And Acceptance of The New Universal Health Insurance Scheme Among Healthcare Workers, Community Members, And Insurance Providers in Nyamagana District, Mwanza Region, North-Western Tanzania
PY  - 2024///.
CY  -  Mwanza, Tanzania | 
PB  - Catholic University of Health and Allied Sciences [CUHAS-Bugando] |   
KW  -  
N2  - 

Abstract:

Background: Universal health insurance schemes have been implemented in various countries to improve healthcare access, financial protection, and service quality. The new Universal Health Insurance Scheme (UHIS) in Tanzania, which has not yet been introduced, presents a significant opportunity to enhance healthcare access. However, the success of UHIS relies heavily on the knowledge, attitude, practices , and acceptability of healthcare workers, community members, and insurance providers. The study aimed to evaluate the level of knowledge, attitudes, and perceptions regarding the UHIS among healthcare workers, community members, and insurance providers, determine its acceptability, and explore their perspectives. Additionally, it seeks to propose strategies to enhance UHIS acceptability.

Methods: This study utilized a multimethod approach that combines a cross-sectional study design for the quantitative aspect and phenomenological qualitative analysis for the qualitative component. A survey, including structured questionnaires, was administered to 615 participants for quantitative data collection. Simultaneously, in-depth interviews were conducted with 17 key informants. Quantitative data were analyzed with the aid of SPSS 25. Descriptive statistics were employed to analyze the characteristics of the study participants, where means, standard deviations, frequencies, percentages, and proportions were used to describe the variables. Inferential statistics, such as chi-square tests and logistic regression, were utilized to explore associations between variables. Statistical significance was determined using a p-value of less than 5%. With the help of NVIVO 12, qualitative data were analyzed using thematic content analysis.

Results: In this study, community members comprised the largest group, 337 (54.8%) followed by healthcare providers, 198 (32.2%) and insurance providers 80 (13.0%). All participants in this study had heard of health insurance, though a minority 102 (16.6%) had heard of UHI. Eight percent expressed doubt about the scheme’s accessibility. In this study, 154 (24.9%) of respondents expressed willingness to enroll, while a majority of 51.1% (314/615) indicated they would not. Insurance providers were significantly more likely to enroll (AOR = 5.276 [95% CI, 2.786, 9.995], p = 0.000 than healthcare providers and community members. Health centers demonstrated significantly higher odds of enrolling in the UHI scheme, AOR = 10.285 [95% CI, 4.299, 24.608], p-value = 0.000. In contrast, private facilities were less likely to enroll AOR = 0.498 [95% CI, 0.287, 0.864], p = 0.013). Awareness of UHI premium contributions notably decreased the likelihood of enrollment, AOR = 0.367 [95% CI, 0.194, 0.694], p = 0.002).
Qualitative insights uncovered distinct yet overlapping expectations among participants regarding the UHIS. These expectations encompassed hopes for enhanced access to healthcare and affordability, alongside a clear demand for effective communication and training.

Conclusions: While the quantitative results indicated a lack of awareness of the Universal Health Insurance (UHI) among many participants, qualitative findings revealed that fewer participants demonstrated a willingness to enroll in the scheme. This discrepancy can be partly explained by the fact that the qualitative data were gathered from key informants who are either directly involved in healthcare or familiar with health insurance matters. Their perspectives may have been shaped by their roles and knowledge, resulting in a more nuanced understanding of the UHIS's potential benefits. To enhance UHIS acceptability and enrollment, it is recommended that targeted awareness campaigns and educational programs about UHI premiums and benefits be implemented.

Keywords: Universal Health Insurance Scheme, acceptability, healthcare workers, community members, insurance providers, Nyamagana District, Tanzania

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