Determinants of enrollment of informal sector workers in cooperative based health scheme in Bangladesh

Sarker, Abdur Razzaque and Sultana, Marufa and Mahumud, Rashidul Alam and Ahmed, Sayem and Islam, Ziaul and Morton, Alec and Khan, Jahangir A. M. (2017) Determinants of enrollment of informal sector workers in cooperative based health scheme in Bangladesh. PLOS One, 12 (7). e0181706. ISSN 1932-6203 (

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Background: Providing access to affordable health care for the informal sector remains a considerable challenge for low income countries striving to make progress towards universal health coverage. The objective of the study is to identify the factors shaping the decision to enroll in a cooperative based health scheme for informal workers in Bangladesh and also help to identify the features of informal workers without health schemes and their likelihood of being insured. Methods: Data were derived from a cross-sectional in-house survey within the catchment area of a cooperative based health scheme in Bangladesh during April–June 2014, covering a total of 784 households (458 members and 326 non-members). Multivariate logistic regression model was used to identify factors associated with cooperative based health scheme and explanatory variables. Findings: This study found that a number of factors were significant determinants of health scheme participation including sex of household head, household composition, occupational category as well as involvement social financial safety net programs. Conclusion: Findings from this study can be suggestive for policy-makers interested in scaling up health insurance for informal workers in Bangladesh. Shared funding from this large informal sector can generate new resources for healthcare, which is in line with the healthcare financing strategy of Bangladesh as well as the recommendation of the World Health Organization for developing social health insurance as part of the path to Universal Health Coverage.