Community-based health insurance in low-income countries: a systematic review of the evidence

BACKGROUND Community Based Health Insurance (CBHI) is a type of health insurance program that provides financial protection against the cost of illness and improving access to health care services for communities engaged in the informal sector. In Ethiopia, the coverage of CBHI enrolment varies across regions and decision of household enrolment is affected by different factors. OBJECTIVE The aim of this systematic review and meta-analysis was to identify the pooled coverage of CBHI enrolment in Ethiopia to understand its policy implications. METHODS The systematic review and meta-analysis was done by adhering the PRISMA guideline with exhaustive search in PubMed/Medline, HINARI, SCOPUS and Google scholar complemented by manual search. Two authors independently selected studies, extracted data, and assessed quality of studies. The I2 test statistic was used to test heterogeneity among studies. The overall coverage of CBHI scheme was estimated by using random-effects model. RESULTS Among 269 identified, 17 studies were included in this meta-analysis and the overall coverage of CBHI scheme was 45% (95% CI 35%, 55%) in Ethiopia. The sub-group analysis shows higher enrolment rate 55.97(95%CI: 41.68, 69.77) in earlier (2016-2017) studies than recent 37.33(95%CI: 24.82, 50.77) studies (2018-2020). CONCLUSIONS The pooled coverage of CBHI enrolment is low in Ethiopia compared the national target of 80% set for 2020. It is also concentrated in only major regions of the country. Due attention to be given to improving geographic expansion of CBHI and to the declining coverages with in the CBHI implementing regions by addressing the main bottlenecks restraining coverages. CLINICALTRIAL Registration: the protocol of this systematic review and meta-analysis was published in PROSPERO with registration number: CRD42021252762

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

10.21203/rs.3.rs-121840/v1 ◽

2020 ◽

Author(s):

Berhanu Bifato ◽

Amanuel Ayele ◽

Muse Rike ◽

Dalecha Dangura

Keyword(s):

Health Insurance ◽

Confidence Interval ◽

Low Income ◽

Associated Factors ◽

Statistical Significance ◽

Multivariable Analysis ◽

P Value ◽

Community Based ◽

Community Based Health Insurance ◽

Insurance Enrollment

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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