Determinants of uptake of national hospital insurance fund primary care scheme among service providers within the scope of NHIF Nakuru town branch

Abstract

There is a growing international consensus on the importance of providing social protection through financing and providing access to healthcare services. Kenya has embraced this through the National Hospital Insurance Fund (NHIF). Despite these efforts, the uptake of the NHIF primary care scheme among service providers in the country is still low. This study sought to assess the uptake of NHIF primary care scheme amongst service providers within the scope of NHIF Nakuru Town branch. The study objectives were to: determine the influence of knowledge of service providers, examine the influence of perceived benefits of the NHIF primary care scheme, establish the influence of health facility organization capacity, and determine the influence of barriers associated with NHIF and health facilities on the uptake of NHIF primary care scheme. The study adopted a cross-sectional research design targeting 120 service providers from 60 health facilities as well as getting key information about the scheme from officers in NHIF office managing the scheme as key informants. A random sample of 96 service providers was drawn from 48 health facilities and 2 officers from NHIF Nakuru branch. Data was collected using a structured questionnaire and an in-depth guide. Quantitative data was analyzed using descriptive and inferential statistics with the aid of Statistical Package for Social Sciences version 21.0 while content analysis was used to analyze qualitative data. From the findings of this study, there was a significant, weak, positive correlation between knowledge of NHIF and uptake of NHIF primary care scheme (r =.266, p<.05). Pearson correlation computed between perceived benefits of NHIF Primary care scheme and uptake of NHIF scheme was significant, moderate and positive (r=.297, p<.05). The health facilities had adequate; ICT facilities, human resource and physical facilities for effective implementation of NHIF primary care. Pearson correlation coefficient between health facility organization capacity on the uptake of NHIF scheme was not significant (r=.109, p<.05). Thus, it was concluded that variations in the level of the health facility organization capacity was independent of the uptake of NHIF primary care scheme. All the constraints combined were likely to negatively impact on the uptake of NHIF primary care. Results of Pearson correlation revealed that the relationship between barriers of the health facilities on the uptake of NHIF primary scheme was moderate, significant and negative (r =-.246, p<.05). The study therefore concluded that NHIF should develop clear policy details on the various benefits and risks involved for health facilities that are not willing to take up the implementation of the scheme. The study recommends that the management of the NHIF scheme should i) embark on a campaign of knowledge dissemination and education of all potential consumers of their services, ii) develop clear policy details on the various benefits and risks involved for health facilities, and iii) sensitize the management of health facility on the requirements for accreditation for provision of NHIF out patient services.