Influence Of Employment Status on the Retention of National Health Insurance Coverage in the Unorganized Sector in Homa Bay County, Kenya

Retaining health insurance coverage among informal sector workers is a persistent challenge, particularly in low-income countries like Kenya. This study investigates the influence of employment status on the retention of National Health Insurance Fund (NHIF) coverage among informal sector workers in Homa Bay County. A descriptive cross-sectional survey design was employed, with data collected from a stratified random sample of 382 respondents across three key locations in the county: Homa Bay, Mbita, and Oyugis. Of these, 363 responses were completed and analyzed, yielding a response rate of 95%. Descriptive findings indicate that 53% of respondents were wage earners, while 47% were self-employed. Gender distribution was nearly balanced, with 55% female and 45% male participants, and the majority (40%) were aged 30–39 years. Analysis revealed that wage earners were significantly more likely to retain NHIF coverage, with 75% retention among wage earners compared to only 45% among self-employed individuals. Regression analysis showed that employment status alone explained 80% of the variance in NHIF retention, with demographic factors such as age, education, and marital status also contributing significantly. Qualitative findings from focus group discussions highlighted barriers faced by self-employed workers, including income instability and limited financial literacy, which hindered consistent NHIF contributions. These findings underscore the critical role of employment stability and demographic factors in sustaining health insurance coverage. Policy recommendations include implementing flexible NHIF payment plans, enhancing financial literacy programs, and providing subsidies for low-income workers to improve NHIF retention among the informal sector, advancing Kenya’s Universal Health Coverage goals.