Does the Informal Sector in Kenya Have Financial Potential to Sustainably Prepay for Health Care? Implications for Financing Universal Health Coverage in Low-Income Settings.

Kenya currently lacks evidence on whether income in the informal sector is sustainable and predictable and therefore able to support financing of universal health coverage (UHC). This article demonstrates the financial potential of informal sector entities to sustainably finance UHC in Kenya. Data were collected using a standardized questionnaire on the following topics: nature and sustainability of informal sector entities, indicators of financial potential, and socioeconomic status. Both descriptive and multivariate analyses were used. The findings indicate that income in the informal sector is generally low although investors in health/medical, stationery, entertainment, manufacturing and craft as well as transportation tend to have higher and more consistent incomes than most others in both sites. Mean monthly incomes ranged from 16.7 USD (lowest) to 786.5 USD (highest). The urban informal sector recorded higher mean monthly incomes of 195.8 USD compared to 77.9 USD in the rural area (P < 0.001). The most sustainable entities in the urban area included stationery (67%), repair and maintenance (50%), food vending (49%), shopkeeping (48%), and clothing and beauty products (43%). Farming (90%), manufacturing and craft (86%), and health/medical (100%) were the most sustainable in the rural area. Key predictors of sustainable informal sector entities include monthly expenditure patterns, gender, marital status, household structure, number of employees in an entity, and land ownership in the rural area and number of entities owned. Informal sector entities are mostly unsustainable, meaning that the majority of premium contributors will not be consistent in payment and will likely to require subsidies.