Abraham Elisante, Gray Cindy, Fagbamigbe Adeniyi F, Tediosi Fabrizio, Otesinky Brianna, Haafkens Joke, Mhalu Grace, Mtenga Sally
School of Life Sciences and Bio-engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania.
Institute of Health and Wellbeing, University of Glasgow, Bagamoyo, Tanzania.
AAS Open Res. 2021 Sep 1;4:45. doi: 10.12688/aasopenres.13289.1. eCollection 2021.
Health insurance is a crucial pathway towards the achievement of universal health coverage. In Tanzania, health-financing reforms are underway to speed up universal health coverage in the informal sector. Despite improved Community Health Fund (iCHF) rollout, iCHF enrolment remains a challenge in the informal sector. This study aimed to explore the perspectives of local women food vendors (LWFV) and (motorcycle taxi) drivers on factors that challenge and facilitate their enrolment in iCHF. A qualitative study was conducted in Morogoro Municipality through in-depth interviews with LWFV (n=24) and drivers (n=26), and two focus group discussions with LWFV (n=8) and drivers (n=8). Theory of planned behaviour (TPB) constructs (attitude, subjective norms, and perceived control) provided a framework for the study and informed a thematic analysis focusing on the barriers and facilitators of iCHF enrolment. The views of LWFV and drivers on factors that influence iCHF enrolment converged. Three main barriers emerged: lack of knowledge about the iCHF (attitude); negative views from friends and families (subjective norms); and inability to overcome challenges, such as the quality and range of health services available to iCHF members and iCHF not being accepted at non-government facilities (perceived control). A number of facilitators were identified, including opinions that enrolling to iCHF made good financial sense (attitude), encouragement from already-enrolled friends and relatives (subjective norms) and the belief that enrolment payment is affordable (perceived control). Results suggest that positive attitudes supported by perceived control and encouragement from significant others could potentially motivate LWFV and drivers to enroll in iCHF. However, more targeted information about the scheme is needed for individuals in the informal sector. There is also a need to ensure that quality health services are available, including coverage for non-communicable diseases (NCDs), and that non-government facilities accept iCHF.
医疗保险是实现全民健康覆盖的关键途径。在坦桑尼亚，正在进行卫生筹资改革，以加快非正规部门的全民健康覆盖。尽管改进了社区卫生基金（iCHF）的推广，但在非正规部门，iCHF的参保率仍然是一个挑战。本研究旨在探讨当地女性食品摊贩（LWFV）和摩的司机对影响他们参保iCHF的因素的看法，这些因素既有挑战性，也有促进作用。通过对24名LWFV和26名摩的司机进行深入访谈，以及与8名LWFV和8名摩的司机进行两次焦点小组讨论，在莫罗戈罗市开展了一项定性研究。计划行为理论（TPB）的构成要素（态度、主观规范和感知控制）为该研究提供了框架，并为聚焦iCHF参保障碍和促进因素的主题分析提供了依据。LWFV和摩的司机对影响iCHF参保因素的看法趋于一致。出现了三个主要障碍：对iCHF缺乏了解（态度）；朋友和家人的负面看法（主观规范）；以及无法克服挑战，如iCHF成员可获得的卫生服务质量和范围，以及非政府机构不接受iCHF（感知控制）。确定了一些促进因素，包括认为参保iCHF在经济上是明智的（态度）、已参保的朋友和亲戚的鼓励（主观规范）以及认为参保费用负担得起（感知控制）。结果表明，在感知控制和重要他人的鼓励支持下的积极态度可能会促使LWFV和摩的司机参保iCHF。然而，非正规部门的个人需要更多关于该计划的有针对性的信息。还需要确保提供高质量的卫生服务，包括非传染性疾病（NCD）的覆盖范围，并确保非政府机构接受iCHF。
Zotero 插件