Exploring a community-based health micro-takaful framework : an empirical study on adoption determinants in Sudan

Abstract

Access to affordable healthcare remains a major challenge in Sudan, particularly for low-income populations. Health Micro-Takaful (HMT) offers a potential solution by providing financial protection against medical expenses. This study investigates the factors influencing HMT adoption in Sudan using the Theory of Planned Behaviour (TPB), with awareness and affordability as extended variables and behavioural intention as a mediator. It also explores policy-related challenges and opportunities for HMT implementation. A mixed-methods approach was applied. Quantitatively, data from 428 respondents were collected via an online questionnaire and analysed using Structural Equation Modelling (SEM) with SmartPLS 3.9. Qualitatively, in-depth interviews with key stakeholders and policymakers were thematically analysed to capture opportunities and challenges. Findings show that attitude, perceived behavioural control, and subjective norms significantly influence adoption when intention is included as a mediator, while awareness and affordability were insignificant. In the direct model, attitude and awareness were significant predictors, but affordability, perceived behavioural control, and subjective norms were not. Qualitative results reveal that lack of specific regulation, economic instability, and limited public awareness hinder adoption, while willingness for policy reforms, digital solutions, and support from Zakat funds and NGOs present key opportunities. This study contributes to the literature on HMT in developing economies by highlighting behavioural, economic, and policy dimensions of adoption. It provides practical insights for regulators, insurers, and development organizations. Strengthening regulatory frameworks, leveraging technology, and raising public awareness are critical for sustainable implementation. Future research should assess the long-term impact of HMT on healthcare access, explore hybrid funding through waqf and CSR, and conduct comparative studies across contexts.