Access to quality and affordable health services is a fundamental human right. However, challenges to the financing of health care services have persisted especially in developing countries. Financial resources are crucial for purposes of buying medicines and supplies, construction of health facilities, and payment of health workers among others . But for most developing countries, health care funding is heavily reliant on out-of-pocket expenditure which limits access to quality health services especially for the poor plus increased disease burden and poverty. Out-of-pocket payments per capita grew from US$ 14 in 2000 to US$ 18 in 2017 in low-income countries . Therefore, there is a need for more reliable, affordable, and sustainable approaches to financing health services to achieve universal health coverage under Goal 3 of the Sustainable Development Goals (SDGs).
Health insurance (HI) presents one of the possible solutions to help address the high and ever-increasing health care costs. HI is a means of making periodic prepayments to enable one to receive health services when the need arises without paying out-of-pocket . The increased interest in HI can be partly attributed to the need by countries to reduce the high dependence on out-of-pocket expenditure as a health service financing mechanism . Except for Uganda, other East African countries have implemented National Health Insurance (NHI) schemes placing them a step ahead towards achieving the World Health Organization (WHO) maximum household health expenditure percentage which stands at 15% of Current Health Expenditure (CHE). As of 2015/16, this stood at 37% for Uganda . Currently, a section of the population is voluntarily covered by private health insurance (PHI) schemes where the highest proportion is covered by their employers and the remainder paying their own HI premiums.
In Uganda, the proportion of women and men with HI improved slightly from 1% and 2%, respectively, in 2011 to 6% each in 2016  which is still very low. Several studies have been carried out to assess willingness to pay for HI [7, 8, 9] but this is preceded by the willingness to join. Some of the factors reported influencing willingness to join HI include household education status, the experience of borrowing for medical expenses, sex of household head, household animal asset [10, 11, 12], socioeconomic status , age family size, community-level horizontal trust, individual social capital , employment status . This calls for a need to ascertain possible factors that could explain the willingness or unwillingness to join health insurance schemes among the population.
This paper aimed to identify factors associated with willingness to join a health insurance scheme among females in Uganda.