Factors Influencing the Uptake of the Akwa Ibom State Health Insurance Scheme among Low-Income Households in Uyo Local Government Area, Akwa Ibom State

Abstract

Background: The Akwa Ibom State Health Insurance Scheme (AKSHIS) was established to extend affordable healthcare coverage to residents, particularly low-income households, yet enrolment within this population in Uyo Local Government Area (LGA) continues to vary widely. This study identified and quantified the socio-economic, cultural, and informational factors that influence uptake of AKSHIS among low-income households in Uyo LGA. Methods: A cross-sectional, multi-stage sample of 406 low-income household heads was drawn from five wards and ten communities in Uyo LGA. Data on socio-demographic characteristics, awareness, perceived importance and accessibility of care, cultural beliefs, and enrolment status were collected using a structured field instrument and analyzed using descriptive statistics, Pearson correlation, chi-square tests, binary logistic regression, and structural equation modelling (SEM). Indicators were classified across health determinants including preventive, promotive, palliative, and rehabilitative care. Results: Overall, 67.0% of respondents were currently enrolled in AKSHIS. Awareness of the scheme (β = 1.65, p < 0.001), monthly household income (β = 1.35, p < 0.001), educational attainment (β = 0.75, p = 0.001), perceived importance of quality healthcare (β = 0.60, p < 0.001), and accessibility of accredited facilities (β = 0.50, p < 0.001) were significant positive predictors of enrolment. Cultural beliefs portraying the scheme as unreliable (OR = 0.43, p = 0.005) and perceptions of insurance as a financial burden (OR = 0.52, p = 0.020) significantly reduced the odds of enrolment. Among non-enrollees, insufficient information (50.2%) and premium cost (32.5%) were the primary barriers cited. Conclusion: Uptake of AKSHIS among low-income households in Uyo LGA is jointly shaped by socio-economic status, awareness, perceived quality and accessibility of care, and cultural trust rather than any single determinant. Subsidised tiered premiums, sustained community-based education, and culturally sensitive trust-building interventions integrated within global health Universal Health Coverage (UHC) frameworks are recommended to raise enrolment.