scholarly journals The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ramadhani Kigume ◽  
Stephen Maluka
Keyword(s):  
Health Insurance ◽  
Community Health ◽  
Rural Areas ◽  
Health Coverage ◽  
Access To Health Services ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Urban Districts ◽  
Health Fund ◽  
The Government

Abstract Background Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.

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

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.

scholarly journals The effect of a community-based health insurance on the out-of-pocket payments for utilizing medically trained providers in Bangladesh

2019 ◽  
Vol 12 (4) ◽  
pp. 287-298 ◽  
Author(s):  
Jahangir A M Khan ◽  
Sayem Ahmed ◽  
Marufa Sultana ◽  
Abdur Razzaque Sarker ◽  
Sanchita Chakrovorty ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health Coverage ◽  
Community Based ◽  
Quality Healthcare ◽  
Informal Workers ◽  
Community Based Health Insurance ◽  
Out Of Pocket Payments ◽  
Significant Difference ◽  
Case Comparison ◽  
Quasi Experimental

Abstract Background We aimed to estimate the effect of the community-based health insurance (CBHI) scheme on the magnitude of out-of-pocket (OOP) payments for the healthcare of the informal workers and their dependents. The CBHI scheme was piloted through a cooperative of informal workers, which covered seven unions in Chandpur Sadar Upazila, Bangladesh. Methods A quasi-experimental study was conducted using a case-comparison design. In total 1292 (646 insured and 646 uninsured) households were surveyed. Propensity score matching was done to minimize the observed baseline differences in the characteristics between the insured and uninsured groups. A two-part regression model was applied using both the probability of OOP spending and magnitude of such spending for healthcare in assessing the association with enrolment status in the CBHI scheme while controlling for other covariates. Results The OOP payment was 6.4% (p &lt; 0.001) lower for medically trained provider (MTP) utilization among the insured compared with the uninsured. However, no significant difference was found in the OOP payments for healthcare utilization from all kind of providers, including the non-trained ones. Conclusions The CBHI scheme could reduce OOP payments while providing better quality healthcare through the increased use of MTPs, which consequently could push the country towards universal health coverage.

scholarly journals Does Community-Based Health Insurance Protect Women from Financial Catastrophe After Cesarean Section? A Prospective Study from a Rural Hospital in Rwanda

2021 ◽  
Author(s):  
Rachel Koch ◽  
Theoneste Nkurunziza ◽  
Niclas Rudolfson ◽  
Jonathan Nkurunziza ◽  
Laban Bikorimana ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cesarean Section ◽  
Controlled Trial ◽  
Poverty Line ◽  
Health Coverage ◽  
Financial Risk Protection ◽  
Community Based ◽  
Community Based Health Insurance ◽  
The Cost ◽  
Universal Health

Abstract BackgroundThe implementation of community-based health insurance in (CBHI) in Rwanda has reduced out of pocket (OOP) spending for the >79% of citizens who enroll in it but the effect for surgical patients is not well described. For all but the poorest citizens who are completely subsidized, the OOP (out of pocket) payment at time of service is 10%. However, 55.5% of the population is below the international poverty line meaning that even this copay can have a significant impact on a family’s financial health. The aim of this study was to estimate the burden of OOP payments for cesarean sections in the context of CBHI and determine if having it reduces catastrophic health expenditure (CHE). MethodsThis study is nested in a larger randomized controlled trial of women undergoing cesarean section at a district hospital in Rwanda. Eligible patients were surveyed at discharge to quantify household income and routine monthly expenditures and direct and indirect spending related to the hospitalization. This was used in conjunction with hospital billing records to calculate the rate of catastrophic expenditure by insurance group. ResultsAbout 94% of the 340 women met the World Bank definition of extreme poverty. Of the 330 (97.1%) with any type of health insurance, the majority (n=310, 91.2%) have CBHI. The average OOP expenditure for a cesarean section and hospitalization was $9.36. The average cost adding transportation to the hospital was $19.29. 164 (48.2%) had to borrow money and 43 (12.7%) had to sell possessions. The hospital bill alone was a CHE for 5.3% of patients. However, when including transportation costs, 15.4% incurred a CHE and including lost wages, 22.6%. ConclusionTo ensure universal health coverage (UHC), essential surgical care must be affordable. Despite enrollment in universal health insurance, cesarean section still impoverishes households in rural Rwanda, the majority of whom already lie below the poverty line. Although CBHI protects against CHE from the cost of healthcare, when adding in the cost of transportation, lost wages and caregivers, cesarean section is still often a catastrophic financial event. Further innovation in financial risk protection is needed to provide equitable UHC.

scholarly journals Implications of Contributions to Equity in Access of Health Care: A Case of Community Based Health Insurance Schemes in Kenya

2018 ◽  
Vol 10 (2) ◽  
pp. 90
Author(s):  
Jane W. Gitahi ◽  
Amos Gitau Njuguna
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Financial Risk ◽  
Vulnerable Groups ◽  
Healthcare Sector ◽  
Financial Risk Protection ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Equity In Access ◽  
The Government

The realization of equity goals requires commitment and combination of contributions from all stakeholders in the healthcare sector under the stewardship of the government. The purpose of this study was to examine the mix of contributions in Community Based Health Insurance Schemes (CBHIs) and equity in healthcare in Kenya. The sample was composed of 318 members of management teams drawn from 82 CBHIs. Descriptive statistics, factor analysis, path analysis and multivariate regression analysis in structural modeling equation (SEM) were conducted to determine the mix of contributions in CBHIs and its bearing on equity in healthcare in CBHIs in Kenya. The study concludes that current mix of contributions is not adequate enough to guarantee equity in access of health care for the poor and vulnerable groups. For realization of equity in access of health care governments and sectoral partners should define the place of CBHIs within the national health policy to guide establishment of an optimal combination of contributions in CBHIs for increased access to care and financial risk protection for precluded groups.

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