Socio-Economic Inequalities in Maternal and Reproductive Health Service Utilization Among National Health Insurance Scheme Policyholders in Zambia
DOI:
https://doi.org/10.69614/ejrh.v18i04.1151Abstract
Background: Among the numerous initiatives launched in Zambia to address healthcare challenges and inequalities, the National Health Insurance Scheme (NHIS) stands out as a significant development in the country's healthcare landscape.
Methods: The study employed a quantitative research approach, using a descriptive cross-sectional design to assess the influence of Knowledge of the NHIS and socio-economic factors on the utilization of maternal and reproductive health services in Zambia. The study used a sample size of 385 NIHS policyholders. Data were collected using a well-structured self-administered questionnaire and analyzed using the statistical software STATA 14.0.
Results: The results revealed a clear association between knowledge and utilization of Maternal and Reproductive Health services under the scheme, suggesting that participation in the scheme was primarily higher among individuals with a good understanding of the scheme (66%). A chi-square test showed a statistically significant association between education and willingness to contribute to the scheme (p-value = 0.005). Additionally, a correlation was found between the number of children participants had and their desire to contribute, yielding a p-value of 0.011. Similarly, the study found a significant association between marital status and willingness to contribute to the scheme (p-value = 0.407). these results suggest that participation in the utilization of the scheme increased with good knowledge, education, marital status and number of children.
Conclusions: The study findings revealed a strong association between various socio-economic factors and their influence on willingness to participate in the scheme. The high level of awareness indicates the effectiveness of NHIMA's outreach initiatives.
References
Comfort AB, Peterson LA, Hatt LE. Effect of health insurance on the use and provision of maternal health services and maternal and neonatal health outcomes: a systematic review. J Health Popul Nutr. 2013 Dec;31(4 Suppl 2):81-105. PMID: 24992805.
Adhikari, B., Rattanapan, C., Laosee, O. et al. Effects of health insurance on economic burden and health service utilization among people with noncommunicable diseases in low- and middle-income countries: a systematic review. BMC Public Health 26, 981 (2026). https://doi.org/10.1186/s12889-026-26691-z
Sakala, L., Zyambo, C. & Chavula, M. The role of the National Health Insurance Scheme in strengthening delivery of health services among the elderly at district level in Zambia: a qualitative case study. BMC Public Health 26, 725 (2026). https://doi.org/10.1186/s12889-026-26390-9
2022-2026 Zambia Strategic Plan National Health https://faolex.fao.org/docs/pdf/zam215377.pdf
Sinjela, Kwangaika & Simangolwa, Warren & Hehman, Lindsey & Kamanga, Mpuma & Mwambazi, Wesley & Sundewall, Jesper. (2022). Exploring for-profit healthcare providers’ perceptions of inclusion in the Zambia National Health Insurance Scheme: A qualitative content analysis. PLOS ONE. 17. e0268940. 10.1371/journal.pone.0268940.
Ministry of Health Zambia https://www.moh.gov.zm/?page_id=1155
National Health Insurance Authority (NHIMA). Revised benefit package for public hcps - level 2 & 3 hospitals. 2025
Review of operations of the National. Health Insurance Manage Auth. 2025. https://pmrczambia.com/cgi-sys/suspendedpage.cgi.
Mwambazi WK, Mpundu M. Assessment of access to the National Health Insurance Scheme provided services among enrolee’s at Levy Mwanawasa University Teaching Hospital’s Outpatient Department in Lusaka, Zambia. 2024. https://www.iosrjournals.org/iosr-jnhs/papers/vol13-issue4/Ser-4/C1304040916.
Novignon J, Lanko C, Arthur E. Political economy and the pursuit of universal health coverage in Ghana: a case study of the National Health Insurance Scheme. Health Policy Plan. 2021;36(Supp 1):i14–21. Available from: https://academic.oup.com/heapol/article/36/Supplement_1/i14/6426098. Cited 2025 May
Nwanaji-Enwerem O, Bain P, Marks Z, Nwanaji-Enwerem P, Staton CA, Olufadeji A, Nwanaji-Enwerem JC. Patient satisfaction with the Nigerian National Health Insurance Scheme two decades since establishment: A systematic review and recommendations for improvement. Afr J Prim Health Care Fam Med. 2022 Jan 13;14(1):e1-e10. doi: 10.4102/phcfm.v14i1.3003. PMID: 35144455; PMCID: PMC8831992.
M’bouaffou, F., Buch, E., Olorunju, S. et al. Perceived knowledge of scheme members and their satisfaction with their medical schemes: a cross-sectional study in South Africa. BMC Public Health 22, 1700 (2022). https://doi.org/10.1186/s12889-022-14106-8
Mathiyazhagan K. Willingness to pay for rural health insurance through community participation in India. Int J Health Plan Manag. 1998;13(1):47–67.
Abiola AO, Ladi-Akinyemi TW, Oyeleye OA, Oyeleke GK, Olowoselu OI, Abdulkareem AT. Knowledge and utilisation of National Health Insurance Scheme among adult patients attending a tertiary health facility in Lagos State, South-Western Nigeria. Afr J Prim Health Care Fam Med. 2019 Sep 4;11(1):e1-e7. doi: 10.4102/phcfm.v11i1.2018. PMID: 31588768; PMCID: PMC6779984.
Christmals CD, Aidam K. (2020) Implementation of the National Health Insurance Scheme (NHIS) in Ghana: Lessons for South Africa and Low- and Middle-Income Countries. Risk Manag Healthc Policy. 2 October;13:1879-1904. doi: 10.2147/RMHP.S245615. PMID: 33061721; PMCID: PMC7537808.
Hanawi MK, Vaidya K, Alsharqi O, Onwujekwe O. (2018) Investigating the Willingness to Pay for a Contributory National Health Insurance Scheme in Saudi Arabia: A Cross-sectional Stated Preference Approach. Appl Health Econ Health Policy. Apr;16(2):259-271. doi: 10.1007/s40258-017-0366-2. PMID: 29307076; PMCID: PMC5874278.
Ibeneme, G.C., Ugochukwu, C.G., Ibeneme, S.C. et al. Satisfaction and retention among NHIS enrollees at a tertiary hospital in Ebonyi State, Nigeria: facility-based insights for community-based health insurance policy. BMC Public Health 26, 877 (2026). https://doi.org/10.1186/s12889-025-26175-6
