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

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 cooperativebased 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.