Community Based Health Insurance Enrollment and Associated Factors in Sidama Region, Ethiopia

Abstract

Background: Community based health insurance is accepted as a capable tool of health system improvement and improves the health status of enrollees. Its mechanisms look for to protect low-income households from health related risks through mutual risk sharing at the community level. Even though Government’s efforts, the Community based health insurance enrolment rate remained low. Objective: To assess the community based health insurance enrollment and associated factors in Sidama Region, Ethiopia.Methods: A community based cross-sectional study was conducted in Sidama Region, 2020 using a pretested structured questionnaire. The study was conducted in randomly selected 770 households. The data entry was made by using Epi-info 2007 software. The data was analyzed by using SPSS version 20. Logistic regression statistical model was used to compute odds ratio with its 95% confidence interval to test the associations between dependent and independent variables. Then variables found to have P<0.25 in the bi-variable analysis taken as candidate for multivariable analysis. A P-value of 0.05 with a confidence interval of 95% was used to declare level of statistical significance. Result: Among 770 sampled households, 762 were interviewed and the response rate was 98.9%. About 20.2% of the respondents were enrolled in the scheme. Covariates such as፡ ages 31-59 years(AOR :2.62, 95% CI :1.48-4.66)and >=60 years(AOR : 2.87, 95% CI :1.23-6.74), households who had no formal education(AOR:1.66, 95% CI:1.02-2.72),affordability of premium (AOR:0.28, 95% CI: 0.15-0.54), knowledge on CBHI(AOR: 3.53; 95% CI: 1.21, 10.27) and perceived quality(AOR: 0.52, 95% CI: 0.25-0.87) had statistically significant association with community based health insurance enrollment.Conclusion: The prevalence of community based health insurance enrollment was low. This study identified the need to create knowledge and bring behavioral change in the community on the scheme in general. This study also revealed that regular contribution issue needs improvement based on affordability of households and building their trust on the program and efforts should be devoted to enhance quality of healthcare services to increase the enrollment.

Towards universal health coverage: The level and determinants of enrollment in the Community-Based Health Insurance (CBHI) scheme in Ethiopia: A systematic review and meta-analysis

“…The studies were conducted from 2017 to 2022. Regarding the distribution of the studies across the region, five were from Amhara [ 40 , 41 , 43 , 45 , 47 ], four from Oromia [ 34 , 35 , 44 , 46 ], two from Sidama [ 39 , 42 ], one from Somali [ 37 ], one from Southern Nations, Nationalities, and Peoples’ Region (SNNPR) [ 36 ], and two from Addis Ababa [ 38 , 48 ]. In all of the studies, data was collected by a face-to-face interview using a pretested, interviewer-administered questionnaire ( Table 1 ).…”

“…The effect of affordability (people’s ability to pay) for CBHI enrollment was assessed using the findings of five studies [ 35 , 37 , 42 , 46 , 47 ]. Compared to their counterparts, individuals who thought that the CBHI premium payment was affordable were 2.58 times more likely to enrol in the scheme (OR = 2.58, 95% CI: 1.68, 3.47) ( Fig 7 ).…”

“…Five studies [ 35 , 39 , 42 , 43 , 45 ] were eligible and considered to examine the impact of perceived service quality on enrolment in the CBHI scheme. Respondents who had a positive perception of the quality of health services provided by health facilities were three times more likely to enroll in the CBHI scheme than those who had a negative perception of health service quality (OR = 3.21, 95% CI: 2.04, 4.38) ( Fig 9 ).…”

“…Fifteen studies (11 cross-sectional and 4 case-control) with a total of 8418 study participants were considered [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. Both the minimum (n = 262) [41] and the maximum(n = 1014) [43] sample size were from the Amhara region.…”

“…Five variables were found to be determinants of CBHI enrolment: affordability of payment for the scheme, knowledge of respondents on the CBHI scheme, perceived quality of service, trust in the scheme, and presence of a person with chronic disease in the household. The effect of affordability (people's ability to pay) for CBHI enrollment was assessed using the findings of five studies [35,37,42,46,47]. Compared to their counterparts, individuals who thought that the CBHI premium payment was affordable were 2.58 times more likely to enrol in the scheme (OR = 2.58, 95% CI: 1.68, 3.47) (Fig 7).…”