Determinants of Non-enrollment on Health Insurance among Women in Sierra Leone: a cross-sectional analysis of the 2019 Sierra Leone Demographic Health Survey

Abstract

Background Health insurance enrollment is key to attaining universal health coverage. Yet, its enrollment in Sierra Leone remains persistently low, posing a public health challenge requiring attention. This study examined the factors associated with non-enrollment of health insurance among women aged 15–49 in Sierra Leone. Methods We analysed data from a weighted sample of 15,574 women aged 15–49 from the 2019 Sierra Leone Demographic and Health Survey. Percentages were used to present the proportion of health insurance enrollment among the women. Multivariable binary logistic regression analysis was used to examine the factors associated with health insurance non-enrollment among the women. The results were presented using adjusted odds ratios (aOR), with their respective 95% confidence interval (CI). Statistical significance was set at p < 0.05. Results The proportion of health insurance non-enrollment among the women was 96.0%. Women with higher education had lower odds of non-enrollment (aOR = 0.36, 95% CI = 0.20, 0.65) than women with no education. Women who are employed (aOR = 0.50, 95% CI = 0.38, 0.66) and those who listen to the radio less than once a week (aOR = 0.61, 95% CI = 0.46, 0.81) had lower odds of non-enrollment than those unemployed and those who do not listen to the radio, respectively. Women who lived in Northwestern (aOR = 0.07, 95% CI = 0.04, 0.15) and Northern regions (aOR = 0.29, 95% CI = 0.13, 0.67) have lower odds of non-enrollment than women living in the Eastern region. Women who watched television less than once a week (aOR = 1.766, 95% CI = 1.04, 3.01) and those who had a big problem with distance to health facilities (aOR = 2.46, 95% CI = 1.08, 5.59) had higher odds of non-enrollment than women who do not watch television at all and do not have a big problem with it. Conclusions Health insurance non-enrollment remains very high among women in Sierra Leone. Education, employment, exposure to media, distance to health facilities, and region are associated with low health insurance enrollment among women in Sierra Leone. Therefore, implementing targeted outreach programs involving community-based initiatives, workshops, and informational campaigns should be used to encourage women to enrol in health insurance. Again, efforts should be made to eliminate financial barriers that prevent women from being able to afford health insurance enrollment.