ACCEPTABILITY AND WILLINGNESS TO PAY FOR UGANDA’S PROPOSED NATIONAL HEALTH INSURANCE SCHEME AMONG INFORMAL SECTOR WORKERS IN IGANGA AND MAYUGE DISTRICTS

Abstract

Introduction: Access to health care remains a challenge especially among the informal sector in most of the low-income countries due to out of pocket (OOP) expenditures, with Uganda spending over 40.0% out of pocket on health care. To solve this, Uganda has proposed a National health insurance scheme (NHI). However, the acceptability, willingness and ability to pay for the proposed NHI scheme within the informal sector has not been explored. Objective: To assess the willingness to pay for the proposed NHI scheme and its determinants among the informal sector workers in Iganga and Mayuge districts Methodology: This was a cross sectional study. It was conducted in Iganga and Mayuge districts in June 2019. A contingent valuation method using the bidding game technique was used to elicit the willingness to pay. A total of 853/781,948 informal sector workers were randomly selected to participate in the study. Six key informant interviews with health workers and 7 FGDs with informal sector workers were also conducted. Logistic regression was done to identify the determinants for willingness to pay for the proposed NHI scheme. Results: The majority (85.2%) of the respondents would accept the proposed scheme. Most respondents (81.5%) were willing to pay for NHI, the median WTP was UGX 25,000 (USD 6.8) and 74.2% of the respondents believed that they were able to pay for health insurance. The factors that were significantly associated with WTP included; Occupation. Wealth, hearing about health insurance, use of traditional medicine and having saving group membership. Conclusion and Recommendation: The level of acceptability and willingness to pay was high. Therefore, it is viable for MOH to introduce and extend NHI to the informal sector but with affordable premiums while ensuring that the quality of services is enhanced.