Customer Perceived Benefits on the Retention of Child Health Insurance; A Case of Toto Afya Card Scheme Under NHIF in Ilemela District
Purpose of the Study: The study aimed to examine the effect of perceived benefits (services quality, coverage and affordability) on the retention of beneficiaries under the Toto Afya Card scheme in Tanzania. The study also explored qualitative insights from insurance officers and beneficiaries to understand the practical challenges and perceptions surrounding the scheme’s benefits and renewal processes.
Design/Methodology: A mixed-methods research design was adopted, combining quantitative and qualitative approaches. Quantitative data were collected through structured questionnaires distributed to beneficiaries of the Toto Afya Card scheme, while qualitative data were gathered through semi-structured interviews with NHIF insurance officers. Statistical techniques, including correlation and regression analyses, were used to test the relationships between perceived benefits (services quality, coverage and affordability) and retention. Thematic analysis was employed to interpret qualitative responses for deeper contextual understanding.
Findings: The findings revealed that perceived affordability is the most influential predictor of beneficiary retention under the Toto Afya Card scheme. While service quality and coverage adequacy also contributed to retention, their effects were comparatively weaker. Qualitative insights indicated that beneficiaries generally view the scheme as affordable for basic services but noted dissatisfaction due to the limited coverage for specialized care and the annual expenditure ceiling.
Originality: This study contributes original empirical evidence on how perceived affordability shapes household decisions to retain child health insurance coverage in Tanzania. By integrating both quantitative and qualitative findings, the study provides a comprehensive understanding of financial perceptions, service adequacy, and user experience under a community-based health insurance model. It extends the application of Expectation Confirmation Theory and SERVQUAL dimensions to the context of child health insurance schemes in low-income settings.
Practical Implications: The results suggest that maintaining affordable premiums, expanding benefit packages, and simplifying digital renewal systems can significantly enhance beneficiary retention. Policymakers and NHIF administrators should consider introducing flexible payment plans, revising coverage limits, and intensifying education on digital self-service platforms to improve ease of renewal and user satisfaction.
Social Implications: Improving affordability and accessibility of the Toto Afya Card will contribute to increased health insurance coverage among children, reducing financial vulnerability and advancing progress toward universal health coverage in Tanzania. Strengthening trust and satisfaction with public health insurance systems can also foster long-term community engagement and equity in healthcare access.
Keywords: Perceived affordability, retention, Toto Afya Card, health insurance, NHIF, Tanzania, universal health coverage, community-based health financing.
