Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria

Enrollment in Ethiopia’s Community-Based Health Insurance Scheme

“…As compared to other similar schemes in Africa, the costs for an entire household to enroll in the Ethiopian scheme lies at the lower end of the cost spectrum. For example, schemes in Burkina Faso (Parmar, Reinhold, Souares, Savadogo, & Sauerborn, 2012), Ghana (Mensah, Oppong, & Schmidt, 2010), and Nigeria (Onwujekwe, Onoka, Uzochukwu, Okoli, Obikeze, & Eze, 2009) are more expensive while schemes in Mail (Franco, Diop, Burgert, Kelley, Makinen, & Simpara, 2008) and Rwanda (Saksena, Antunes, Xu, Musango, & Carrin, 2011) are as costly as the Ethiopian scheme.…”

Achieving Equity in Health through Community-based Health Insurance: India's Experience with a Large CBHI Programme

“…This exclusion effect has been observed among others by Jutting (2004) for Senegal, and Ranson et al (2006Ranson et al ( , 2007 and Sinha et al (2006) for India in the context of the selected CBHI programmes. In contrast, Onwujekwe et al (2009) andPolonsky et al (2009) find strong evidence of equity in a successful large CBHI programme in Nigeria and Oxfam's CBHI programmes in Armenia, respectively. In a qualitative investigation of demand for health insurance in rural West Africa, De Allegri et al (2006) suggest that the equity aspect of a CBHI programme largely depends on its technical design.…”

“…The most important reasons for inequity (Jakab and Krishnan, 2004;Criel and Waelkens, 2003) are believed to be the inability to afford the premiums and poor accessibility to hospitals providing services under these programmes. Onwujekwe et al (2009) attribute inequity to implementation strategies, insufficient community involvement in the programme planning, lack of trust in the programme or its managers or voluntary membership strategy while Lahkar and Sundaram-Stukel (2010) find moral hazards and high administrative cost as important factors which inflate the cost and discourage the poorest from enrolling. Preker et al (2002) in their survey of literature conclude that trained and competent management with strong involvement and ownership of the community contribute to the objective of inclusion.…”

Public health care financing in Nigeria: Which way forward?

“…[53][54][55] Enrolment is affected by factors such as trust by the community in the organizer or manager of the scheme, attractiveness of the benefit package, affordability of the premium, and the quality of the health care. [56] To improve enrolment in Nigeria, the adoption of a sliding scale of premiums, such that financial contributions are set according to ability to pay has been suggested. [53,54] Atugbe et al also reported that if varied forms of payment are allowed, such that households can choose to make contributions in whatever forms of payment they could afford, enrolment rate will be increased.…”