Search

Effective citizen engagement is crucial for the success of social health insurance, yet little is known about the mechanisms used to involve citizens in low- and middle-income countries. This paper explores citizen engagement efforts by the National Health Insurance Fund (NHIF) and their impact on health insurance coverage within rural informal worker households in western Kenya. Our study employed a mixed methods design, including a cross-sectional household survey (n  = 1773), in-depth household interviews (n  = 36), six focus group discussions with community stakeholders and key informant interviews (n  = 11) with policymakers. The findings reveal that NHIF is widely recognized, but knowledge of its services, feedback mechanisms and accountability systems is limited. NHIF enrolment among respondents is low (11%). The majority (63%) are aware of NHIF, but only 32% know about the benefit package. There was higher awareness of the benefit package (60%) among those with NHIF compared to those without (28%). Satisfaction with the NHIF benefit package was expressed by only 48% of the insured. Nearly all respondents (93%) are unaware of mechanisms to provide feedback or raise complaints with NHIF. Of those who are aware, the majority (57%) mention visiting NHIF offices for assistance. Most respondents (97%) lack awareness of NHIF's performance reporting mechanisms and express a desire to learn. Negative media reports about NHIF's performance erode trust, contributing to low enrolment and member attrition. Our study underscores the urgency of prioritizing citizen engagement to address low enrolment and attrition rates. We recommend evaluating current citizen engagement procedures to enhance citizen accountability and incorporate their voices. Equally important is the need to build the capacity of health facility staff handling NHIF clients in providing information and addressing complaints. Transparency and information accessibility, including the sharing of performance reports, will foster trust in the insurer. Lastly, standardizing messaging and translations for diverse audiences, particularly rural informal workers, is crucial. [ABSTRACT FROM AUTHOR]

Abstract The World Health Assembly of 2005 called for all health systems to move towards universal coverage, defined as "access to adequate health care for all at an affordable price". [...]

Background: Healthcare systems across the globe are adopting patient-centred care (PCC) approach to empower patients in taking charge of their illnesses and improve the quality of care. Although models of patient-centredness vary, respecting the needs and preferences of individuals receiving care is important. South Africa has implemented an integrated chronic disease management (ICDM) which has PCC component. The ICDM aims to empower chronic care patients to play an active role in disease management process, whilst simultaneously intervening at a community/population and health service level. However, chronic care is still fragmented due to systemic challenges that have hindered the practice of PCC. In this article, we explore provider perspectives on PCC for patients with comorbid type 2 diabetes and HIV at a public tertiary hospital in urban South Africa. Methods: This study utilizes ethnographic methods, encompassing clinical observations, and qualitative interviews with healthcare providers (n = 30). Interview recordings were transcribed verbatim and data were analyzed inductively using a grounded theory approach. Results: Providers reported various ways in which they conceptualized and practiced PCC. However, structural challenges such as staff shortages, lack of guidelines for comorbid care, and fragmented care, and patient barriers such as poverty, language, and missed appointments, impeded the possibility of practicing PCC. Conclusion: Health systems could be strengthened by: (i) ensuring appropriate multidisciplinary guidelines for managing comorbidities exist, are known, and available, (ii) strengthening primary healthcare (PHC) clinics by ensuring access to necessary resources that will facilitate successful integration and management of comorbid diabetes and HIV, (iii) training medical practitioners on PCC and structural competence, so as to better understand patients in their sociocultural contexts, and (iv) understanding patient challenges to effective care to improve attendance and adherence. [ABSTRACT FROM AUTHOR]