Factors determining membership in community-based health insurance in West Africa: a scoping review

Abstract

Background In many low-income countries, households bear most of the health care costs. Community-based health insurance (CBHI) schemes have multiplied since the 1990s in West Africa. They have significantly improved their members’ access to health care. However, a large proportion of users are reluctant to subscribe to a local CBHI. Identifying the major factors affecting membership will be useful for improving CBHI coverage. The objective of this research is to obtain a general overview of existing evidence on the determinants of CBHI membership in West Africa. Methods A review of studies reporting on the factors determining membership in CBHI schemes in West Africa was conducted using guidelines developed by the Joanna Briggs Institute. Several databases were searched (PubMed, ScienceDirect, Global Health database, Embase, EconLit, Cairn.info, BDPS, Cochrane database and Google Scholar) for relevant articles available by August 15, 2022, with no methodological or linguistic restrictions in electronic databases and grey literature. Results The initial literature search resulted in 1611 studies, and 10 studies were identified by other sources. After eliminating duplicates, we reviewed the titles of the remaining 1275 studies and excluded 1080 irrelevant studies based on title and 124 studies based on abstracts. Of the 71 full texts assessed for eligibility, 32 additional papers were excluded (not relevant, outside West Africa, poorly described results) and finally 39 studies were included in the synthesis. Factors that negatively affect CBHI membership include advanced age, low education, low household income, poor quality of care, lack of trust in providers and remoteness, rules considered too strict or inappropriate, low trust in administrators and inadequate information campaign. Conclusions This study shows many lessons to be learned from a variety of countries and initiatives that could make CBHI an effective tool for increasing access to quality health care in order to achieve universal health coverage. Coverage through CBHI schemes could be improved through communication, improved education and targeted financial support.

Household satisfaction and associated factors with community-based health insurance scheme in Ethiopia: systematic review and meta-analysis

“…No study was excluded from the reviews using the above appraisal tools. The following criteria were utilized to evaluate cross-sectional studies: (1) adherence to inclusion criteria, (2) clear description of study subjects and settings, (3) utilization of valid and reliable exposure measurements, (4) utilization of objective and standardized criteria, (5) identification of confounding factors, (6) implementation of strategies to address confounding, (7) appropriate outcome measurement, and (8) utilization of suitable statistical analysis (Table 2).…”

“…Evidence showed that various sociodemographic characteristics, including age, educational status, income, and distance to healthcare facilities, influence enrolment in CBHI schemes. Additionally, factors related to the health facilities, such as the quality of care provided, trust in administrators, and access to information about CBHI, also play crucial roles in determining CBHI membership [7,8]. Another challenge LMICs face in the context of CBHI schemes is a high dropout rate among enrolled members [9,10].…”

Willingness to join community-based health insurance and its associated factors among households in Nekemte City, Ethiopia. A community-based cross-sectional study

“…Additionally, factors related to the health facilities, such as the access to information about CBHI, also play crucial roles in determining CBHI membership [ 26 ]. The current study revealed that being informed about the scheme was significantly associated with the willingness to join for community-based health insurance.…”

Mandatory membership of community-based mutual health insurance in Senegal: A national survey

“…In their search for solutions to cover their citizens with health insurance, African countries face many challenges and have tested various strategies (1). In Francophone West Africa, community-based health insurance (CBHI) has long been the preferred instrument for covering populations in the informal and rural sectors (2)(3)(4). However, while evidence shows CBHIs protect their members (3,5), their penetration rates are very low.…”

“…In Francophone West Africa, community-based health insurance (CBHI) has long been the preferred instrument for covering populations in the informal and rural sectors (2)(3)(4). However, while evidence shows CBHIs protect their members (3,5), their penetration rates are very low. In Senegal, less than 5 % of the population is affiliated with a CBHI (6,7) despite membership being subsidized and the fact that they have been at the heart of the health financing policy for over a decade (8)(9)(10).…”