The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis

Bayked, Ewunetie Mekashaw; Toleha, Husien Nurahmed; Kebede, Seble Zewdu; Workneh, Birhanu Demeke; Kahissay, Mesfin Haile

doi:10.1080/16549716.2023.2189764

Cited by 10 publications

(1 citation statement)

References 78 publications

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“…The CBHI is a non-profit mechanism for insuring the poor to enable them to access basic healthcare services ( 8 ). It applies the principles of insurance in the social context and is guided by the communities’ preferences and based on their structures and arrangements.…”

Section: Introductionmentioning

confidence: 99%

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Getaneh¹,

Bayked

Workneh

et al. 2023

Front. Public Health

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BackgroundThe fundamental concept of community-based health insurance is to strengthen the healthcare financing system to access universal healthcare by reducing costly risk-coping strategies. The scheme’s sustainability and the quality of services provided by it are highly dependent on the satisfaction of its beneficiaries. Despite beneficiaries’ satisfaction being the key determinant for providing evidence for policy revision and decision-making, it has often been neglected. Therefore, the study investigated the community-based health insurance beneficiaries’ satisfaction and associated factors in Legambo district, North-East Ethiopia.MethodsThe study was conducted in the Legambo district with a community-based cross-sectional study design from October to November 2019. The data were collected from 838 households that had been the beneficiaries of the scheme using multi-stage and systematic random sampling. Twelve trained data collectors were employed and gathered the data using a pre-tested, structured questionnaire. We ran descriptive, bivariate, and logistic regression analyses. A value of p less than 0.05 with a 95% CI was used in multivariate logistic regression to determine the association of variables with the beneficiaries’ satisfaction.ResultsThe overall satisfaction level of the beneficiaries of the scheme was 58.6% and was associated with the following factors: merchandize (AOR = 1.92, 95% CI = 1.02–3.63), living in rural areas (AOR = 1.52, 95% CI = 1.02–2.27), an early office opening time (AOR = 3.81, 95% CI = 2.04–7.10), a short time interval to use benefit packages (AOR = 4.85, 95% CI = 2.08–11.31), an inexpensive membership premium (AOR =10.58, 95% CI = 3.56–31.44), availability of laboratory services (AOR =2.95, 95% CI = 1.71–5.09), presence of referral services (AOR =1.93, 95% CI = 1.33–2.80), having immediate care at health facilities (AOR = 1.73, 95% CI = 1.01–2.97) and non-compulsory enrolment (AOR = 6.31, 95% CI = 1.64–24.20).ConclusionThe beneficiaries’ satisfaction with the scheme was suboptimal and found to be determined by occupation, residence, laboratory and referral services, immediate care, office opening time, time interval to use benefit packages, premium amount, and situation of enrollment, most of which are service-related variables. Thus, to improve the satisfaction level, the stakeholders that should work hard seem to be the health insurance agency (the insurer) and the health facilities (the provider or supplier).

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Section: Introductionmentioning

confidence: 99%

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Getaneh¹,

Bayked

Workneh

et al. 2023

Front. Public Health

Self Cite

View full text Add to dashboard Cite

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Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

Endalamaw,

Mengistu,

Khatri

et al. 2024

Preprint

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Background: Universal health coverage (UHC) is a critical target in many health system strategies to achieve the ‘good health and wellbeing’. Evidence on the meaning and scope of UHC and the strategies required to achieve it are needed, as variations in its understanding and implementation have risen. We synthesised evidence on the meaning, components, significance, and strategies of UHC. Methods: A review of evidence was conducted based on realist synthesis. We searched PubMed, EMBASE, Scopus, and Web of Science for published materials and websites for grey literature. We have followed some steps: define the scope of the review and develop initial programme theory, search for evidence, data extraction, and synthesis of evidence. Results: Universal coverage, universal health, universal healthcare, universal access, and insurance coverage are used interchangeably with UHC. It is a legal notion that embodies a human rights-based and collaborative approach to ensure fair and comprehensive health care services. Universal health coverage is relevant for three macro reasons: first, it prevents and reduces the impact of diseases; second, it addresses inequality and promotes equity; and third, it is key for global health security. Various mechanisms involved to implement UHC, such as health insurance, social health protection, digital financing systems, value-based care, private sectors, civil societies, partnership, primary health care, and reciprocal health care systems. Conclusions: Universal health coverage is a multifaceted concept that can be expressed by various terms in different contexts. Universal health coverage is a political and ethical imperative that aims to promote health equity and protect human dignity across different levels of society. It is essential in preventing diseases and serving a crucial role in global health security. Practically, UHC is not truly universal, as it does not include all services under its scheme and varies across countries. This requires consistent advocacy, strategic and operational research as well as political will to ensure UHC.

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Voices From the Frontline: A Reflexive Thematic Analysis Illuminating Perioperative Practice Realities in Southern Ethiopian Teaching Hospitals

Mulugeta,

Zemedkun,

Mergia

et al. 2024

Qual Health Res

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Despite national efforts, gaps persist in Ethiopian perioperative care. This reflexive thematic analysis aimed to investigate the contextual challenges faced in delivering perioperative care. In-depth interviews were conducted with 20 healthcare professionals, including anesthetists, nurses, and surgeons, to gain a frontline perspective of perioperative practice realities. The analysis revealed eight interconnected themes: systemic infrastructure vulnerabilities, workforce expansion uncertainties, workforce demoralization, fragile perioperative safety culture, hierarchical structures and communication barriers, financial barriers to care, fragmented information systems, and fragile governance with sociopolitical instability. Local deficiencies in resources and equipment were amplified by global challenges, creating a precarious care environment. While workforce numbers increased, concerns persisted about competency and training quality. Systemic pressures and unmet professional needs contributed to staff demoralization. Inconsistent safety practices and top-down quality improvement initiatives hindered sustainable progress. Rigid hierarchies and departmental silos impeded effective teamwork and resource coordination. Financial constraints created significant barriers to care access and ethical dilemmas for providers. Incomplete digitalization and inconsistent documentation practices compromised continuity of care and data-driven improvements. Overarching sociopolitical instability and weak governance cascaded into healthcare system disruptions. The findings underscore the need for a multifaceted approach to strengthen perioperative care, including improving infrastructure, enhancing workforce development, fostering a culture of safety, breaking down hierarchical barriers, addressing financial accessibility, implementing robust information systems, and building resilient governance structures amidst adversity.

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The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis

Cited by 10 publications

References 78 publications

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

Voices From the Frontline: A Reflexive Thematic Analysis Illuminating Perioperative Practice Realities in Southern Ethiopian Teaching Hospitals

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