Trial reportBMC public health2025
Effect of financial health risk protection education on health insurance knowledge and enrollment willingness among rural households in Tanzania: a cluster randomized controlled trial.
Trial report in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMany countries have introduced health insurance schemes to accelerate progress toward Universal Health Coverage (UHC) and improve access to healthcare. However, limited awareness of catastrophic health expenditures and the risk of impoverishment from healthcare costs may hinder enrollment. In Tanzania, these gaps underscore the importance of financial health risk protection education as a strategy to enhance insurance knowledge and enrollment willingness, especially among rural households.
objectiveTo measure the effect of financial health risk protection education on knowledge and willingness to enroll in health insurance among rural households in Tanzania.
methodsThe study was a cluster-randomized controlled trial. Total of 560 household heads were assigned randomly to a control or intervention group (280 in each group). A questionnaire was used to collect data. Intervention group received education for 1 month then was followed for 2 months. Outcomes measured were change in knowledge on financial health risk protection, health insurance for all and willingness to enroll. Logistic regression was conducted to establish a relationship between knowledge and willingness to enroll.
resultsThe odds of knowledge about financial health risk protection and health insurance for all increased substantially in the intervention households at endline compared to baseline. Participants in the intervention group were two times more likely to have adequate knowledge about financial health risk protection at the endline compared to the baseline study [(OR = 0.478, p = 0.005) baseline to (OR = 2.3, p < 0.0001) endline]. Similarly, participants in the intervention group were more likely to have adequate knowledge about health insurance at the endline compared to the baseline study [(OR = 0.20, p = 0.29) baseline to (OR = 1.4, p < 0.0001) endline]. The odds of willingness to enroll in health insurance increased two times more in the intervention households at the endline compared to the baseline study [(OR=-0.28, p = 0.18) baseline to (AOR = 2.2, p < 0.0001) endline].
conclusionFinancial health risk protection education significantly improved knowledge and willingness to enroll in health insurance among rural households, demonstrating its potential to promote insurance uptake. Scaling up such educational interventions in rural Tanzania is recommended to address knowledge gaps, enhance enrollment, and advance progress toward Universal Health Coverage.
trial registrationThe trial was registered on 11th April 2023, with registry number PACTR202304503715724, Clinical trial number not applicable.
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