Factors Influencing Access to Health Services for NHIF Insured Persons within Makadara Constituency, Nairobi County, Kenya

Abstract

The National Health Insurance fund (NHIF) users constantly face challenges with access to health care with a 30% consumption rate. This gap prevents adequate access to health care hence low levels of treatment options available. The specific objective of this study was to determine factors influencing access to health services within Makadara constituency in Nairobi County. These included sociodemographic characteristics, knowledge on NHIF benefits, processes and frequency of drug supply. The respondents were randomly selected using the NHIF database. A Descriptive survey was used and the target population were patients accessing health services within the constituency. Simple random sampling method was used with a sample size of 400 respondents studied over a 5-month period. The inclusion criteria were adult registered members (1 year) conversing in English/Kiswahili and mentally competent. Minors less than 18 years, mentally unstable and vernacular speakers were excluded. Questionnaires were used with the primary outcome being the number of patients accessing NHIF services. Data analysis was done using SPSS v.24. Data was presented in tables, charts and graphs with explanations following. Response rates were 100% with Cronbach’s reliability alpha test of 0.7. The results showed that majority were male, 26-33 years and married. The highest education level was the diploma level followed by degree holders. Majority had at least 4 children, under 4 household occupants and resided in Buruburu. They had National covers (86.5%), primary members (81.25%) and their dependents were registered. 78.25% had accessed a health facility in the recent past while 44.8% were not sure. Despite this, 23% agreed the NHIF card allowed better access to health services (p value <0.05). NHIF knowledge of benefits, processes and frequency of drug supplies positively influenced health accessibility (p=0.037, p=0.027, p=0.001) respectfully. The respondents who were not aware of the NHIF benefits were 0.543 times less likely to access health services. This was similar to those not aware of NHIF processes (OR 0.466) and who experienced infrequent drug supply (OR 0.437). All the variables except sociodemographic characteristics positively influenced access (p<0.05). The main recommendation is that to ensure universal health coverage for all, NHIF processes need to be streamlined, users made aware of benefits and institutions ensure a constant drug supply chain.