Abstract
Background
The drive towards achieving universal health coverage has led most countries to introduce national health insurance schemes, with contribution that are payroll based and thus easily capture those employed in the formal sector. For many countries with informal sectors constituting over 80% of the labor force, there are daunting questions on how to extend coverage. Zambia recently adopted the national health insurance scheme and faces questions on how to collect contributions from its informal sector, which constitute more than 85% of the labor force. Expansion of insurance to wider community relies on high levels of trust and private information about those to be insured, which community-based organizations such as savings groups (SGs), wield. This study explored perspectives on harnessing community SGs for contribution collection in the Zambia national health insurance scheme.
Methods
We conducted an exploratory qualitative research study in two districts of Zambia comprising of nine focus group discussions and eight in-depth interviews. Three focus group discussions were conducted in Choma District and six were conducted in Kalomo District, with a total of 88 participants. Using the motivation and ability framework, which stipulates triggers, abilities, motivation and action, data were analyzed using thematic analysis approach.
Results
Participants indicated that there are existing “insurance” features in the SGs that can be leveraged on and makes them appreciate the concept of insurance. They emphasized the importance of enhanced knowledge about the national health insurance scheme at community level as a key trigger to facilitate engagement of the savings group members. The ability of these groups to be used for contribution collection was strengthened by the presence of a collective constitution governing members. Furthermore, the results revealed a promising opportunity to utilize mobile technology to collect contributions from rural communities. Notably, the motivation within the community was underscored by the recognition of social advantages emanating from the savings group and the members' eagerness to contribute towards healthcare coverage. Most of the community members expressed willingness to contribute towards the scheme using the SGs. They considered sickness to be unpredictable, and hence insurance was imperative to cover them and their families. However, participants identified potential threats to using the SGs for contribution collection, including inconsistent income, mishandling of contributions, and instability within saving groups.
Conclusions
Although our study suggests that its feasible to use savings groups for contribution collection, there use might require government oversight including developing policies that sustain, support, and strengthen capacity to administer member contributions towards insurance cover. Strategic interventions, including financial management measures and the integration of technology, can enhance the efficacy of leveraging savings groups for sustained and inclusive healthcare coverage.