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  • 1.
    Msaki, John
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Assessment of factors associated with uptake and continuity of the Community Health Insurance scheme in the Rural Tanzania: A study protocol2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The government of Tanzania is committed to achieve Universal health coverage. To address this a Community health Insurance Fund (CHF) was introduced which provides financial protection against the cost of illness and improving access to quality health services for low-income rural households who are excluded from formal insurance. Since its establishment in Tanzania its enrolment has been regressive due to many reasons one being affordability and poverty. This is a study protocol for which the objective is to plan a study aiming at exploring the reasons for low uptake of the CHF in the rural Tanzania.

    Methods: The planned study will deploy a mixed method approach. Questionnaire will be administered to a total of 1660 households randomly sampled from the same area. To complement quantitative data, two Focus group discussions will be conducted comprising of household members and members from ward/village health committees. The logistic regression model will be used to assess the dependent effect of CHF and an outcome variable.

    Expected results: The planned study will help better understanding of the Community Health Insurance in Tanzania and help to reveal important aspects to be addressed in order to improve the scheme in Tanzania.

  • 2.
    Msaki, John
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Household Catastrophic Health Expenditures among older people in Ghana: The WHO Study on Global Ageing and Adult health (SAGE) Wave 12019Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: There is a growing number of old people globally and Out of pocket payment remains the main means of health care financing which has a risk of financial catastrophes and impoverishment. The problem is likely to be more pronounced to the older and poor population as a result household develop mechanisms to cope with the financial burden they are facing. The study investigates factors associated with household Out of Pocket and catastrophic health expenditures, and mechanisms for coping with it for the households with older people.

    Methods: A cross-sectional multistage stratified cluster sampling of 4377 50+ year’s households were used from the WHO Study on Global Ageing and Adult Health Ghana collected in 2007-8. The social demographic characteristics, social economic variable and household expenditure variables were assessed. The Multiple logistic and linear regressions were used to measure the association between outcome variables and the respective predictor variables.

    Results: Of all the households, 75% incurred some OOPE in the last 30 days; 33% faced catastrophic health expenditure; and 1.8% was impoverished. Out of pocket expenditure was more common in rural and non-poor households. Female headed households had a 31% lower risk of facing CHE than male headed households. Having household member who needs care increased the risk of CHE and the higher the income quintile the lower the risk of facing CHE. Most households used their current income savings to cope with OOPE. However, 15% both sold household items and borrowed money from financial institutions as a mechanism to cope with OOPE.

    Conclusions: Efforts to strengthen National Health Insurance Scheme to ensure equitable access to health care and prioritization of intervention to the rural, poor and older population should be done in order to reduce dependency on Out of pocket expenditure to finance health care.

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