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Who remains uncovered? Assessing inequalities and determinants of national health insurance enrolment among informal sector workers in Kenya

Many sub-Saharan African countries are increasingly adopting national health insurance policies to improve access to essential services. Informal sector workers, however, often lack coverage because their earnings are typically not low enough to qualify for government subsidies but insufficient to cover insurance premiums, resulting in a phenomenon known as "missing middle". This paper examined socioeconomic inequalities in national health insurance enrolment and determinants of participation among informal sector workers in Kenya. We used nationally representative cross-sectional household survey data (n = 5168) collected from informal sector workers in Kenya in December 2020. First, we examined levels of national health insurance enrolment among informal sector workers. Second, we examined socioeconomic inequalities in national health insurance enrolment using concentration curves and the Wagstaff index. Third, we employed a three-level mixed effects logistic regression model to assess the determinants of national health insurance enrolment. Overall, 21.75% (95% Confidence Interval 20.63–22.89) of informal sector workers in Kenya were enrolled in the national health insurance scheme. We observed pro-rich inequalities in national health insurance enrolment, with a concentration index of 0.35 (95% CI 0.30–0.41). Older age (adjusted odds ratio (AOR) = 1.66, 95% CI 1.31–2.10), employment in the non-agricultural sector (AOR = 1.96, 95% CI 1.60–2.39), microfinance institutional membership (AOR = 1.44, 95% CI 1.23–1.69), higher education level (AOR = 2.49, 95% CI 1.99–3.11), household’s prior positive experience with healthcare (AOR = 1.45, 95% CI 1.22–1.72), and higher socioeconomic status based on the wealth asset index (AOR = 3.87, 95% CI 2.97–5.05) were all significantly positively associated with national health insurance enrolment. Larger households had lower odds of enrollment (AOR = 0.76, 95% CI 0.60–0.96). Our findings suggest that enrollment rates among informal sector workers remain low, and important pro-rich inequalities prevail. Economic factors, education, and prior experience with healthcare services were key drivers of national health insurance enrollment. Further policies are needed to increase enrollment among informal sector workers, including differential premium levels, reliance on expanded targeted subsidies, and enhanced awareness campaigns. Our findings are also applicable to other low-resource settings experiencing conditions similar to those in Kenya as they transition toward national health insurance policies, with the goal of achieving universal health coverage.

Latest news - Next SEDE meetings - Committee on Security and Defence


The following extraordinary SEDE meetings will take place:

  • Thursday, 11 December 2025 from 12:00 - 13:00 in Brussels;
  • Monday, 15 December 2025 from 19:45 - 22:30 in Strasbourg,
    including SEDE/ENVI/ITRE Committees meeting from 19:45 - 20:00 and SEDE/IMCO Committees meeting from 20:00 - 20:30.
The next ordinary meeting of the Committee on Security and Defence (SEDE) is scheduled to take place on Thursday, 15 January 2026 from 9.00 - 12.30 a in Brussels (room SPINELLI 5G3).
Further information about the SEDE meetings can be found here.

_______________________

SEDE missions 2025:
  • Djibouti - 27-29 October 2025
  • Greenland - 15-19 September 2025
  • Norway - 27-30 May 2025
  • Moldova and Ukraine - 14-17 April 2025
  • Bosnia and Herzegovina - 24-27 February 2025
  • Israel and Palestine - 5-8 February 2025
SEDE missions 2024:
  • United Kingdom - 28-30 October 2024
  • Ukraine - 25-26 October 2024

SEDE Committee meetings' calendar 2025
SEDE Committee meetings' calendar 2026
EP calendar 2025
EP calendar 2026
Source : © European Union, 2025 - EP

2040 climate target: Council and Parliament agree on a 90% emissions reduction

Europäischer Rat (Nachrichten) - Wed, 12/10/2025 - 03:15
The Council and the Parliament have reached a provisional agreement to amend the climate law by setting a 90% emissions reduction target for 2040, with flexibilities for member states and the EU during the transition.

Press release - 2040 climate target: deal on a 90% emissions reduction in EU climate law

Europäisches Parlament (Nachrichten) - Wed, 12/10/2025 - 00:23
Co-legislators agree on a 90% reduction target for greenhouse gas emissions by 2040, compared with 1990 levels, to achieve a climate neutral EU by 2050.
Committee on the Environment, Public Health and Food Safety

Source : © European Union, 2025 - EP

Myanmar: Statement by the High Representative on behalf of the European Union on the upcoming elections

Europäischer Rat (Nachrichten) - Wed, 12/10/2025 - 00:15
The High Representative issued a statement on behalf of the European Union on the upcoming elections in Myanmar.

Letzter Wunsch erfüllt: Die Kessler-Zwillinge wurden beerdigt

Blick.ch - Tue, 12/09/2025 - 20:56
Die Kessler-Zwillinge fanden ihre letzte Ruhe nun auf dem Waldfriedhof Grünwald. Die Urnen von Alice und Ellen Kessler wurden am Dienstag im Grab ihrer Mutter beigesetzt, wie sie es sich gewünscht hatten: in aller Stille und zu zweit.

Einziger Schweizer in «Politico»-Ranking: Zeitung kürt Infantino zu «Europas erfolgreichstem Trump-Flüsterer»

Blick.ch - Tue, 12/09/2025 - 20:52
Die US-Tageszeitung «Politico» hat ein neues Ranking der einflussreichsten Personen in Europa veröffentlicht. Unter ihnen ist, als einziger Schweizer, auch Fifa-Boss Gianni Infantino.

Press remarks by President António Costa following the meeting with Taoiseach of Ireland, Micheál Martin

Europäischer Rat (Nachrichten) - Tue, 12/09/2025 - 18:14
Press remarks by President António Costa following the meeting with Taoiseach of Ireland, Micheál Martin.

Press briefing - Economic and Financial Affairs Council of 12 December 2025

Europäischer Rat (Nachrichten) - Tue, 12/09/2025 - 18:14
Press briefing ahead of the Economic and Financial Affairs Council will take place on 11 December at 13.30. The briefing will be "off the record".

Human Rights Day: Statement by the High Representative on behalf of the European Union

Europäischer Rat (Nachrichten) - Tue, 12/09/2025 - 18:14
The EU issued a statement on Human Rights Day stressing that it remains steadfast in its commitment to safeguard human rights at home and abroad, and to ensure peace, truth, justice and accountability.

Tagung des Europäischen Rates vom 18./19. Oktober – Einladungsschreiben von Präsident António Costa an die Mitglieder des Europäischen Rates

Europäischer Rat (Nachrichten) - Tue, 12/09/2025 - 18:14
Der Präsident des Europäischen Rates António Costa hat die Führungsspitzen der EU zur Tagung am 18./19. Dezember 2025 in Brüssel eingeladen. Dort werden sie über die folgenden Themen sprechen: Ukraine, Naher Osten, nächster Mehrjähriger Finanzrahmen, EU-Erweiterung, Migration sowie Geoökonomie und Wettbewerbsfähigkeit.

Bővíti a megye a zselízi Perla szociális intézmény épületét

Bumm.sk (Szlovákia/Felvidék) - Tue, 12/09/2025 - 17:40
Nyitra megye önkormányzata bővíti a zselízi Perla szociális létesítmény (ZSS) épületét, egy kétszintes komplexumot építenének.

PS a vasúti incidensről – Rážnak azonnal le kell mondania

Bumm.sk (Szlovákia/Felvidék) - Tue, 12/09/2025 - 17:37
Michal Šimečka (PS) szerint Jozef Ráž közlekedési miniszternek azonnal távoznia kell posztjáról a Liptóújvár és Liptószentmiklós közötti rendkívül veszélyes vasúti incidens miatt. Kijelentette: a Fico-kormány vezetése alatt szétesik az ország.

DRAFT OPINION on the Commission’s 2025 Rule of Law report – annual report 2025 - PE781.246v01-00

DRAFT OPINION on the Commission’s 2025 Rule of Law report – annual report 2025
Committee on Foreign Affairs
Adrián Vázquez Lázara

Source : © European Union, 2025 - EP

Összeütközött egy teherautó és egy kocsi

Bumm.sk (Szlovákia/Felvidék) - Tue, 12/09/2025 - 17:11
Összeütközött egy teherautó és egy személygépjármű az I/17-es úton Kenyhecnél (Kechnec), a Kassa-vidéki járásban. Az érintett útszakaszt mindkét sávon lezárták. Az autóban egy gyermek is utazott, eszméleténél van, ellátják a mentősök. Az esetről Facebook-bejegyzésében tájékoztatott a Kassai Kerületi Rendőrkapitányság.

Kaja Kallas: Washington bírálatának Oroszországra kellene irányulnia

Bumm.sk (Szlovákia/Felvidék) - Tue, 12/09/2025 - 17:01
Az Európai Unió a szabadság lényegét jelenti, és az Egyesült Államok részéről megfogalmazott kritikáknak nem az EU-t, hanem talán Oroszországot kellene célba venniük - jelentette ki Kaja Kallas, az Európai Unió kül-és biztonságpolitikai főképviselője kedden Brüsszelben.

Ukrán hadsereg: az ukrán csapatok kedvezőbb állásokba vonultak vissza Pokrovszknál

Bumm.sk (Szlovákia/Felvidék) - Tue, 12/09/2025 - 16:49
Az ukrán csapatok elhagytak néhány állást a Donyeck megyei Pokrovszk és Mirnohrad mellett, Liszivka és Szuhij Jar településeknél, onnan a parancsokság kedvezőbb védelmi vonalakra helyezte át őket - közölte kedden az ukrán deszant rohamcsapatok 7. hadteste.

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