Awareness and factors associated with NHIF uptake in four counties in Western Kenya

Background: Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary with a higher uptake among formally employed individuals who represent only 16.4% of the population. To improve the voluntary uptake rate of the scheme, it is important to have increased awareness as well as implement strategies that address barriers to NHIF uptake. Methods: This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October 2018 and September 2019.It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive and multiple logistic regression statistical analysis were conducted using STATA version 15. Results: From a representative sample of 3597 participants interviewed, NHIF awareness was noted to be 81.5%, with low uptake rate of 21-25% in the four selected counties. Being older than 69 years, having a low level of education and income status as well as lower health risk were significant barriers to NHIF uptake. Conclusion: Despite high rates of NHIF awareness noted in this study, there is still low uptake of this scheme in rural western Kenya especially among those with low socioeconomic status, advanced age and at risk of chronic illnesses. There is need for further qualitative studies to explore contextual factors affecting NHIF uptake in Western Kenya