Abstract:

The current Social Health Insurance (SHI) model as implemented in Zambia has focused on those in formal employment. This may not favor the SHI model as currently implemented in the Zambian health sector due to extremely low proportion of those employed in the formal sector especially that the current model does not include financial contribution from the informal sector. The paper therefore conducts a systematic review of factors that would be associated with sustainable prepayment in the informal sector. The study was a quantitative cross-sectional study. Multivariate logistic regression was performed to identify factors associated with sustainable prepayment. A total of 426 respondents were interviewed in the study and 56.8 percent were female and 43.2 percent were female. The study revealed that 37.1 percent of respondents supported the idea of making contributions to raise funds for health. 75 percent of those interviewed disagreed that the monthly premium was a good way to collect contributions. The results of the multivariate analysis found that showed that from the factors studied, the one that were associated with sustainable prepayment of health services were higher number of children(OR,0.1;p<0.05),monthly income above 1000 (OR,0.1;p<0.05),monthly expenditure on health needs above K1000(OR,37.6; p<0.05)and nature of business. Those in the nonfood business were more likely to sustainably prepay than those in food business (OR, 2.2; p<0.05). The study recommended expanded coverage through involvement of local and revenue authorities in the collection of levies and reducing high premium costs associated with insurance contributions.

Keywords: informal sector; health prepayment; insurance; contributory; non-contributory.

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