A Conceptual Framework for Community-Based Health Insurance in Low-Income Countries: Social Capital and Economic Development

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.

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Determinants of Community-Based Health Insurance Scheme Enrolment in Developing Countries: A Systematic Review

Asian Journal of Advanced Research and Reports ◽

10.9734/ajarr/2019/v5i330131 ◽

2019 ◽

pp. 1-14 ◽

Cited By ~ 1

Author(s):

G. T. Olowe

Keyword(s):

Developing Countries ◽

Health Insurance ◽

Low Income ◽

Mixed Method ◽

Community Based ◽

Quality Healthcare ◽

Thematic Synthesis ◽

Community Based Health Insurance ◽

The People ◽

The Third World

In developing Nations, the Community-based Health Insurance (CBHI) scheme is a potential approach to increasing access to quality healthcare. It has the potency of generating financial resources for health services; plus improve on the standard of life of the people. Evidence based reports suggest that enrolment into the CBHI is still low, particularly among low income earners of the third world nations. Thus, this study was undertaken to review and help formulate policies by existential evidence on the factors that determines enrolment into the CBHI in developing countries. Study adopted the thematic synthesis of both qualitative and mixed method studies that report the above measure of interest. Study relied on Ovid Medline In-Process and other Non-Indexed citations till present. Study sourced the web of Knowledge, Google Scholar for articles relating to enrolment into CBHI in developing countries. Six studies (qualitative and mixed method studies) reporting qualitative results on the factors determining enrolment into CBHI in developing countries met the inclusion criteria. Quality assessment was carried out on each study and findings were synthesised with the aid of thematic synthesis. Four major themes were identified by interpreting and categorizing the themes across all selected studies; Individual factors, Scheme factors, Service provider factors and Requirement to team up with others before enrolment. In the end, study observed enrolment into CBHI scheme in developing countries to be driven by several factors including age and policy making, most of which positively or negatively influence decisions made by households to enrol or not in the CBHI scheme. Findings from this review are expected to contribute to policy and decision making for health care centres under CBHI scheme in developing countries.

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Willingness to Join Community-Based Health Insurance and Its Associated Factors among Households in West Gojjam Zone, North Mecha Woreda ,Amhara region, Ethiopia

10.21203/rs.3.rs-952468/v1 ◽

2021 ◽

Author(s):

Getaneh Bizuayehu Demeke

Keyword(s):

Health Insurance ◽

Health Services ◽

Low Income ◽

Financial Risk ◽

Systematic Sampling ◽

P Value ◽

Health Coverage ◽

Access To Health Services ◽

Community Based ◽

Community Based Health Insurance

Abstract Background Community-based health insurance schemes are becoming increasingly recognized as a potential strategy to achieve universal health coverage in developing countries. Ethiopia is a low income country with more of health spending out of pocket payment by households. Health insurance is also expected to provide financial protection because it reduces the financial risk associated with falling ill. Therefore; financial risk in the absence of health insurance is equal to the out-of-pocket expenditures because of illness. Method Cross-sectional community based study design was conducted by using a pretested structured questionnaire. Multi-stage cluster, simple random and systematic sampling techniques was used to select 296 households as study units which were allocated to the kebeles proportionately. The sampled households were selected using simple random sampling technique. Bivariate and multivariate logistic regression was used for analysis of variables and 95% confidence level and P value <0.05 was used to measure strength of association. Results A total of 296 sampled study participants, 285 participated in this study with a response rate of 96.3%.From this, (90.9%) were willing to join and (89.8%) of them were willingness to pay CBHI. the benefits of join the scheme were as follows, (86.8%) were reduce OOP expenditure, (8.3%) of them improve health status, (2.3%) were reduce the risk of severity and (2.6%) foster productivity. Conclusions This study showed that the proportion of willingness to join CBHI was higher than the findings of others study in the country and it is encouraging for planned strategy to expanding the scheme throughout the country. The main challenges utilization of health services in government health institutions were absence of available medicine, poor service delivery, lack of enough laboratory, health professional’s lack of good behavior and shortage of ambulance services. To alleviate such problem the government should be encourage access to health services.

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