Kapologwe Ntuli A, Kagaruki Gibson B, Kalolo Albino, Ally Mariam, Shao Amani, Meshack Manoris, Stoermer Manfred, Briet Amena, Wiedenmayer Karin, Hoffman Axel
Regional Medical Office, P.O Box 320, Shinyanga, Tanzania.
President's Office Regional Administration and Local Government (PORALG), P.O Box 1923, Dodoma, Tanzania.
BMC Health Serv Res. 2017 Apr 27;17(1):308. doi: 10.1186/s12913-017-2250-z.
Introduction of a health insurance scheme is one of the ways to enhance access to health care services and to protect individuals from catastrophic health expenditures. Little is known on the influence of socio-demographic and social marketing strategies on enrollment and re-enrollment in the Community Health Fund/Tiba Kwa Kadi (CHF/TIKA) in Tanzania.
This cross-sectional study employed quantitative methods for data collection between November 2014 and March 2015 in Singida and Shinyanga regions. Relationship between variables was obtained through Chi-square test and multivariate logistic regression.
We recruited 496 participants in the study. Majority (92.7%) of participants consented to participate, with 229 (49.8%) and 231 (50.2%) members and non members of CHF/TIKA respectively. Majority (90.9%) were aware of CHF/TIKA. Majority of CHF/TIKA members and non-members (90% and 68.3% respectively) reported health facility-based sensitization as the most common social marketing approach employed to market the CHF/TIKA. The most popular marketing strategies in the country including traditional dances, football games, radio, television, news papers, and mosques/church were reported by few CHF and non CHF members. Multivariate Logistic regression models revealed no significant association between social marketing strategies and enrollment, but only socio-demographics; including marital status (AOR = 2.0, 95% CI 1.1-3.8) and family size (household with ≥ 6 members) (AOR = 1.5, 95% CI 1.0-2.5), were significant factors associated with enrollment/re-enrollment rate.
This study indicated that low level of utilization of available social marketing strategies and socio-demographic factors are the barriers for attracting members to join the schemes. There is a need for applying various social marketing strategies and considering different facilitating and impending socio-demographic factors for the growth and sustainability of the scheme as we move towards universal health coverage.
引入健康保险计划是增加获得医疗服务机会以及保护个人免受灾难性医疗支出影响的途径之一。关于社会人口统计学和社会营销策略对坦桑尼亚社区健康基金/蒂卡关怀基金（CHF/TIKA）参保和再次参保的影响，目前所知甚少。
这项横断面研究于2014年11月至2015年3月期间在辛吉达和希尼安加地区采用定量方法收集数据。变量之间的关系通过卡方检验和多变量逻辑回归获得。
我们招募了496名研究参与者。大多数（92.7%）参与者同意参与，其中分别有229名（49.8%）和231名（50.2%）是CHF/TIKA的成员和非成员。大多数（90.9%）知晓CHF/TIKA。大多数CHF/TIKA成员和非成员（分别为90%和68.3%）报告称，以医疗机构为基础的宣传是用于推广CHF/TIKA的最常见社会营销方式。很少有CHF成员和非CHF成员报告该国最受欢迎的营销策略，包括传统舞蹈、足球比赛、广播、电视、报纸以及清真寺/教堂。多变量逻辑回归模型显示，社会营销策略与参保之间无显著关联，仅有社会人口统计学因素；包括婚姻状况（优势比[AOR]=2.0，95%置信区间[CI]1.1 - 3.8）和家庭规模（家庭中有≥6名成员）（AOR = 1.5，95% CI 1.0 - 2.5）是与参保/再次参保率相关的显著因素。
本研究表明，现有社会营销策略的低利用率以及社会人口统计学因素是吸引成员加入该计划的障碍。在迈向全民健康覆盖的过程中，需要应用各种社会营销策略，并考虑不同的促进和阻碍社会人口统计学因素，以实现该计划的发展和可持续性。
