Awareness, Uptake and factors associated with NHIF uptake in Western Kenya. A case of 4 counties - Busia, Trans Nzoia, Vihiga and Siaya

Abstract 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 hence geared to those in formal employment who represent only 16.4% of the population. To improve the voluntary uptake of the scheme, it is important to have increased awareness as well as implement strategies that address factors that currently affect NHIF uptake. Methods This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October and December 2018. 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 statistical analysis and multiple logistic regression were conducted using STATA version 15. Results Out of a representative sample of 3597 participants interviewed, NHIF awareness was noted to be 81.5%, with low uptake in the four counties ranging between 21–25%. Being older than 69 years, having a low level of education and income status as well as lower health risk were significantly associated with low rates of NHIF uptake. Conclusion Despite high rates of NHIF awareness noted in this study, there is still very low uptake to this scheme in rural western Kenya especially among those with low socioeconomic status and risk of chronic illnesses. There is need for further qualitative studies to explore contextual factors affecting NHIF uptake.