‘The National Health Insurance scheme would be good and beneficial but I don’t trust the system …’: a cross-sectional mixed-methods study assessing the awareness and perceptions towards Uganda’s proposed National Health Insurance scheme among informal sector workers in Iganga and Mayuge districts, Uganda

Abstract

Background Most low-income countries have prioritised implementing national health insurance schemes (NHIs) as a solution to reducing the high out-of-pocket expenditures on health and enhancing access to healthcare, especially among informal sector workers. However, their perceptions remain unexplored in Uganda. This study aimed to assess the awareness and perceptions of the informal sector workers towards the proposed NHIs in Iganga and Mayuge districts, Uganda.Methodology A cross-sectional mixed-methods study was conducted in the Iganga and Mayuge districts of eastern Uganda between April and May 2019. Informal sector workers were randomly selected to participate in the study. Six key informant interviews with health workers and seven focus group discussions with informal sector workers were also conducted. Quantitative data was analysed using STATA V.14. Qualitative data was analysed using a thematic analysis approach.Results A total of 853 respondents participated in the survey: 327/853 (38.3%) were peasant farmers, 248/853 (29.1%) were fishermen, 146/853 (17.1%) were business people and 132/853 (15.5%) were commercial cyclists. Very few, 14/853 (1.6%), were considered knowledgeable about health insurance. The majority 743/853 (87.1%) of the respondents believed that the proposed scheme was beneficial, with a few reservations about lack of trust. Qualitatively, most participants had never heard about health insurance. Most community and health workers welcomed the idea of introducing NHIs in Uganda, although many indicated their lack of trust in the system to deliver a beneficial scheme.Conclusion There was a high level of support for the proposed National Health Insurance scheme since many believed it would be beneficial. However, there was low awareness and a lack of trust in the system to successfully implement a beneficial scheme due to corruption. There is a need for intensive sensitisation campaigns to raise awareness and boost confidence and trust.