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Title: Sudan social health insurance : challenges towards universal access to health care
Author: Abdelrahim, Mahgoub
ISNI:       0000 0004 7655 2880
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2014
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To achieve effective access to health care, countries have adopted various policies to improve the populations' legitimate right to obtain health care when needed. Social health insurance has been proposed by the WHO as a means to securing sustainable access to health care particularly for developing countries. As one of the developing countries, Sudan launched SHI in 1994; however, population coverage still does not exceed 28.7% of the total population. Given the complexities of access to health care, the issue of achieving universal access by the adoption of SHI is faced with various challenges. Recognising the factors that influence an individual's decision to access health care ultimately adds to the success of the policy intervention to meet the stated goals. In addition, understanding and recognising the households' perspectives and motives to affiliate with SHI is critical to the success of the devised policy initiative. Therefore, this thesis examines the determinants of both access to health care and enrolment in social health insurance in Sudan. It also examines the implication of the adoption of social health insurance as a means to improving the population's access to health care. To achieve the stated objectives, the thesis adopted a quantitative cross-sectional study design involving a household survey in Kassala State in Sudan. The household survey (n=560) collected information from 280 voluntary insured households as well as 280 uninsured households living in rural and urban areas of Kassala State. The study confirms that both access to health care and voluntary enrolment in SHI in Sudan are influenced by factors embedded in the Andersen and Penchansky models of access to health care. These factors include the head of the household's; age, place of residence, gender, health status, the number of family members, perception about the waiting time to see the doctor, perception about the staff treatment, the level of knowledge about SHI and the monthly income. The study confirms that SHI does not act directly to improve utilization of health care; instead, its effect is mediated by other factors especially income level. Thus, access to health care is not merely the function of the health insurance status of the population; however, together with empowering the household's income level, improving the supply side of the health delivery system and reducing the gender inequality SHI is more likely to improve the population's access to health care. In addition, the study proves that those who are able to pay the health insurance premium and joined the scheme, are either looking for additional value for money (e.g. getting health services at a cheap price) or escaping an escalating cost of health care resulting from personal costly health status (e.g. chronic illness). Thus, the success of improving voluntary uptake of SHI depends on adding convincing value for money, raising the people's awareness about the scheme especially female households, targeting rural residence, especially those with large family size, and otherwise adopting a compulsory enrolment policy. The thesis contributed to knowledge through the development of a single theoretical framework encompassing both the health seeking behaviour and the adequacy of the health delivery system. The theoretical framework not only studied access to healthcare but also the factors that influence enrolment in health insurance. The new conceptual framework and the thesis's policy implications are applicable to developing countries that adopt SHI and express socioeconomic characteristic and problems resembling that of Sudan. It is also worth mentioning it is the first study to evaluate the impact of Sudan SHI in terms of population access to health care.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available