title: A quantitative study on factors influencing enrolment of dairy farmers in a community health insurance scheme.
abstract: Access to affordable and effective health care is a challenge in low- and middle- income countries. Out-of-pocket expenditure for health care is a major cause of impoverishment. One way to facilitate access and overcome catastrophic expenditure is through a health insurance mechanism, whereby risks are shared and financial inputs pooled by way of contributions. This study examined factors that influenced the enrolment status of dairy farmers in Western Kenya to a community health insurance (CHI) scheme.
  
  
  
  Quantitative, cross-sectional research was used to describe factors influencing the enrolment in the CHI scheme. Quota and convenience sampling was used, recruiting a sample of 135 farmers who supply milk to a dairy cooperation. Data were collected using a structured interview schedule and analysed using Stata SE, Data Analysis and Statistical Software, Version 12.
  
  
  
  Factors influencing non-enrolment were identified as affordability (40%; n = 47), unfamiliarity with the management of the scheme (37%; n = 44) and a lack of understanding about the scheme (41%; n = 48). An exploratory factor analysis was used to reduce the variables to two factors: information provision and understanding community health insurance (CHI). Logistic regression identified factors associated with enrolment in the Tanykina Community Healthcare Plan (TCHP). Supplies of less than six litres of milk per day (OR: 0.22; 95% CI: 0.06-0.84) and information provision (OR: 8.77; 95% CI: 2.25-34.16) were significantly associated with enrolment in the TCHP. Nearly 30% (29.6%; n = 40) of the respondents remarked that TCHP is expensive and 17% (n = 23) asked for more education on CHI and TCHP in an open-ended question.
  
  
  
  Recommendations related to marketing strategies, financial approach, information provision and further research were outlined to be made to the management of the TCHP as well as to those involved in public health.
authors.affiliation: Department of Health Studies, University of South Africa, P.O. Box 392, Unisa 0003, Pretoria, South Africa.|Christian University of Applied Sciences, Ede, Netherlands.
authors.forename: Tineke de Groot-de
authors.initials: TG
authors.lastname: Greef
authors.affiliation: Department of Health Studies, University of South Africa, P.O. Box 392, Unisa 0003, Pretoria, South Africa. monarlv@unisa.ac.za.
authors.forename: Lydia V
authors.initials: LV
authors.lastname: Monareng
authors.affiliation: Department of Health Studies, University of South Africa, P.O. Box 392, Unisa 0003, Pretoria, South Africa.
authors.forename: Janetta H
authors.initials: JH
authors.lastname: Roos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000191:economics; D003430:Cross-Sectional Studies; D000067565:Farmers / Q000523:psychology*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000191:economics*; D007630:Kenya; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Access to community health insurance; Dairy farmers; Enrolment status; Information provision