Inclusive and sustainable financial risk protection for the informal sector : institutional and household factors influencing health insurance coverage in Kenya and Cameroon

Existing literature has largely prioritised an empirical approach towards health financing research, neglecting the contextual considerations that shape the way in which decisions are made. This thesis sought to expand our insight into decision-making at institutional and household level in order to improve the applicability of health financing research to the real-world setting.
Using an interpretivist approach, the thesis investigated the influence of priority-setting by key health financing actors on universal health coverage (UHC) strategy. It further analysed the empirical determinants of voluntary health insurance demand amongst different informal sector groups in Kenya and Cameroon. Finally, it sought to apply social analysis to understand the contextual conditions that shape decision-making at household and institutional level.
This thesis identified a link between the perceived lack of a systematic and inclusive process for UHC in Kenya and divergence amongst key stakeholders on the country’s health financing priorities and values. It further found that voluntary health insurance demand in Kenya and Cameroon is influenced by social position, access to resources that strengthen social or economic interdependence, and by economic power.
It concludes that the socio-cultural and political contexts within which decisions are made are as important to health financing research as the empirical investigation of health-related outcomes. It further articulates the importance of reflecting the complexity of decision-making groups in health financing research design in order to provide more representative analyses that can be applied to the real-world setting.