Determinants of a ccess and uptake of universal health coverage among households of Mwingi west sub-county, Kitui county, Kenya

Abstract

The focus towards the achievement of Universal health coverage (UHC) has been hampered by a number of challenges which includes inadequate sensitization and enforcement of set guidelines, more focus by counties on high-cost interventions rather than on Primary Health Care (PHC), inadequate staff at national and county levels to offer health care service, inadequate financing, poor reporting on the quality-of-service delivery among others. The aim of this study was determinants of access and uptake of universal health coverage among households of Mwingi West Sub-County- Kitui County. The specific objectives were; to determine the awareness levels of UHC, determine socio-economic factors influencing uptake of UHC and determine health systems factors influencing uptake of UHC. Descriptive cross-sectional study design was employed where quantitative and qualitative data was collected using a structured questionnaire and Key Informant Interviews. The study population was households and health workers of Mwingi west. Stratified random sampling was employed to sample wards while simple random sampling was used to sample 422 respondents in the study area using household registers. Data collection tools were piloted in Mwingi North of which was not included in the study. The data was managed using SPSS version 25. Descriptive data was analyzed using measures of central tendency i.e., means, percentages and standard deviation The chi-square test was carried out to establish association between social economic, health system factors and uptake of universal health care. While confidence interval was set at 95%, data was summarized and presented using graphs, tables and charts. Ethical clearance was obtained from Jaramogi Oginga Odinga Teaching and Referral Hospital Institutional and Ethics Research committee. The study targeted 422 participants; however, only 322 of them were accessible. Almost a half, 151 (46.9%) of the participants were aged between 26 to 35 years. More than average, 183 (56.8%) of the respondents were females. Self-employment was the primary mode of livelihood for a high proportion 194(60.2%) of the participants. Most of the study sample, 183 (56.8%) were aware of Universal Health Coverage (UHC). There was a significant association between occupation, educational level, belonging to a social welfare group and awareness of UHC at α ≤ 0.05 (Chi-square: p=0.001, p=0.001, p=0.725, and p=0.0.027) respectively. There was no association between adequate drug availability in health facilities, rating of health service received and awareness of UHC (Chi-square: p=0.800, p=0.120) respectively. An association was found to exist between treatment waiting time, rating of health care workers and awareness of UHC (Chi-square: p=0.001, p=0.002) respectively. There is a need to foster patient experiences at facilities offering UHC services through enhanced quality of service tenable through sustained health care education of health care workers on emerging disease trends. This will allow provision of adequate evidence-based care, which meets the patient’s needs. The County Government of Kitui should develop adequate health promotion strategies aimed at enhancing the awareness of its populace on matters UHC