'Hospitals are medicine and more….' An assessment of subsidised health insurance beneficiaries' experience in Western Kenya

Abstract

Financial protection remains an important hurdle to overcome if Universal Health Coverage is to be achieved in sub-Saharan Africa. An innovative model of subsidised health insurance to vulnerable households was implemented in one level four and two primary health care facilities in Western Kenya. The project aimed to determine whether reduced insurance costs, socioeconomic empowerment, and the availability of drugs would improve patients' experience and encourage them to co-pay. This was a secondary analysis of a mixed methods study with a cross- sectional household survey consisting of 18 semi-structured interviews conducted with NHIF subsidy program beneficiaries. Most beneficiaries accessed care as a result of the program. However, challenges of stockouts and inadequate healthcare workers persisted and discouraged some of them from going to the participating facilities. Community Health Promoters were very instrumental in enlightening the community on the cover and getting the sick beneficiaries to go to the hospital. The socioeconomic empowerment programme was beneficial but was mostly long-term and required financial input from the community members before they could sell the poultry or agricultural produce. Most community members were willing to pay after receiving health services using the cover. The study recommends contextualisation of socioeconomic empowerment programs, which are very important in enabling families to generate income to pay for health insurance. Additionally, improving the service delivery experience is important by reducing stockouts, having sufficient healthcare workers, and eliminating facility-related delays, which would improve the confidence of communities in public health facilities, thus retaining health insurance.