Factors Influencing Utilization of Linda Mama Boresha Jamii Health Insurance by Expectant Mothers in Trans Nzoia County, Kenya.

Abstract

Globally, utilization of Social Health Insurance is wanting and Africa South of the Sahara is the worst affected. In Kenya and more specifically Trans Nzoia County, utilization of social health Insurance services under the brand name Linda Mama Boresha Jamii Insurance (LMBJI) which the Kenya government is utilizing to offer free maternity services to expectant women in order to reduce maternal death rate remains a challenge despite the government’s effort to create awareness. According to Hospital Insurance Fund (NHIF), Trans Nzoia County office records out of 45,472 women who were eligible to use Linda Mama card only 6,453(14%) women used Linda Mama card during their ante natal period in 2017 and during delivery only 6,430(14%) used Linda Mama card. The broad study objective was determining factors influencing utilization of LMBJI cover in Trans Nzoia County. The study was under the Health Financing Pillar of the Health Systems Management. This study adopted descriptive-cross sectional research design with mixed methods approach. The research study was institutional based and it targeted women of reproductive age with confirmed pregnancy and those with babies less than one-year-old. The study had a target population of 45,472.A sample size of 384 was obtained using Cochran’s sample size formula (1977), while 7 Nursing Services Managers working in the sampled health facilities were sampled using purposive sampling technique and were used as key informants. The study also used purposive sampling technique to realize the health facilities study sample. Data collection tools were structured questionnaire for the 384 mothers to realize quantitative data. The study further used key informant interview guide for 7 Nursing Services Managers to realize qualitative data. The research tools were pretested to ascertain reliability and validity. SPSS version 25 was used in coding and analyzing the quantitative data while qualitative data was analyzed thematically and presented in verbatim. The regression equation, taking all factors (Client’s characteristics, NHIF Scheme Characteristics, health facility factors and Health Worker’s Characteristics) to be constant at zero, growth of Linda Mama would be 1.217. The data findings analyzed also showed that taking all other independent variables at zero, a unit increase in Client’s characteristics leads to a 0.746 increase in Utilization of Linda mama; a unit increase in NHIF Scheme Characteristics leads to a 0.778 increase in Utilization of Linda mama, a unit increase in health facility factors leads to a .673 increase in utilization of Linda mama; while a unit increase in health worker’s characteristics leads to a .622 increase in Utilization of Linda mama. This inferred that NHIF Scheme Characteristics, health facility factors, health worker’s characteristics, had the most influence on Utilization of Linda mama with a significance value of (0.000) at 95% level of confidence followed by Client’s characteristics with a significance value of 0.002. The study found out and concluded that client’s characteristics, NHIF scheme characteristics, health facility factors and health worker’s characteristics influenced utilization of Linda mama insurance policy. The study recommended that the implementers of the programme in Trans Nzoia County should focus on improving economic status of the women by creating conducive environment for doing business; the county government of Trans Nzoia should also make sure all roads leading to rural health facilities are passable especially during rainy season while the NHIF scheme should develop and adopt a mobile phone application which can allow as many expectant mothers as possible to register without necessarily visiting health facilities.