Drivers of Member Engagement in Co-operative Health Insurance: Evidence from the Ushirika Afya Scheme in Babati, Tanzania

Abstract

Despite concerted efforts by the Government of Tanzania to expand public healthcare access 
to farmers organised under Agricultural Marketing Co-operative Societies through the 
introduction of Cooperative Health Insurance via the Ushirika Afya scheme in 2019, many 
cooperative members still depend on out-of-pocket payments for healthcare services. To 
address this gap, the present study investigates the factors influencing members’ 
engagement in health insurance through cooperatives. A purposive, face-to-face 
questionnaire survey was conducted with 300 Agricultural Marketing Co-operative Societies 
members who actively participate in the Ushirika Afya scheme. Structural Equation 
Modelling using Amos 26 was employed to analyse the determinants of members’ 
engagement in cooperative health insurance. The results validate the proposed model and 
support its hypotheses. Specifically, the findings highlight the significant roles of attitudes 
towards health insurance, subjective norms, individual health aspirations, and perceived 
behavioural control as predictors of members’ engagement in Cooperative Health Insurance. 
These findings carry practical implications for the design and implementation of cooperative
based health insurance programmes. The study provides valuable insights for key 
stakeholders including Agricultural Marketing Co-operative Societies, the National Health 
Insurance Fund, Cooperative Development Authorities, and policymakers involved in the 
cooperative sector.