Community-based Health Insurance Research Articles

Knowledge and Uptake of Community-Based Healthcare Financing in Management of Non-Communicable Diseases among Community Members in Anambra State, Nigeria

Background: Catastrophic health expenditure is one of the challenges people living with non-communicable disease face, especially in Nigeria. This has led to the emergence of community-based health insurance as a means to achieve universal health coverage and reduce out-of-pocket payments. However, lack of knowledge about the insurance scheme and how it helps to manage non-communicable diseases seems to affect utilization. Aim: The study assessed the knowledge and uptake of community based healthcare financing in the management of non-communicable diseases among community members in Anambra State. Materials and Methods: A descriptive cross-sectional survey design was adopted for the study, sample size was 444 and a multistage sampling technique was used. The instrument for data collection was a self structured questionnaire and data obtained were analyzed using Microsoft excel, descriptive statistics, inferential statistics for hypothesis testing and IBM statistical package for social Sciences (SPSS) version 29. Results: 64.1% had a good knowledge of community based healthcare financing; 51.4% managed their health condition through hospital visits under CBHI. There was a significant relationship between the level of education of respondents and their level of knowledge of community based health insurance (p-value 0.001 < 0.05). Conclusion: Majority had a good knowledge; those suffering pregnancy related non-communicable diseases used the insurance more although half of the respondents still pay through their pocket. The following recommendations were made: increase access to community-based healthcare financing information, encourage those in the informal sector to enroll and plan benefit packages to have wide illness coverage.

Antenatal care services in Yobe state Nigeria: The determinants and interventions to increase utilization

Introduction: Maternal and perinatal mortality are global public health issues and Nigeria in particular carries a high burden as 33,000 women dies every year though significant decline in maternal mortality ratio has been observed; neonatal mortality rate is 37 per 100,000 livebirths against the 2015 MDGs target of 12 per 100, 000 and stillbirth is unbearably high. Yobe State remains one of the regions with high maternal and perinatal death in Nigeria most of which are preventable with quality Antenatal care (ANC) services yet the ANC coverage is only 49% against the Nigerian national figure of 68.9% (which is moderate) and more than 67% of the pregnant women did not receive atleast 4 ANC visits in Yobe as recommended by World Health Organization. The aimed of this study was to analyse and recommend interventions in ANC services in order to increase utilization to improve maternal and perinatal health in Yobe State, Nigeria. Methods: This is an in-depth study on ANC service utilization from local and international literatures; databases used are PubMed, Medline and Global health. The conceptual framework is based on socio ecological model. The analytical tools used to analyse the proposed intervention strategies are based on the criteria of technical effectiveness, organisational feasibility, sociocultural feasibility, financial feasibility and equity consideration. Results: Multilevel determinants are responsible for low Utilization of ANC services in Yobe State which include intrapersonal (women education and literacy), interpersonal (families, peers, relatives influence), community (culture and beliefs), health system (health services, human resources, and health policy) and structural determinants (conflicts and poverty). Effective and feasible strategies to increase ANC services Utilization identified and appraised include outreach and health and education; men involvement in ANC; community based health insurance scheme; improving the skills and supportive supervision of ANC providers; employment of CHW and task shifting to lower cadres. Conclusion: ANC services requires multi-dimensional approach to increase Utilization, each intervention augment one another for the desired effects and better outcome of improving maternal and perinatal health. Further research is recommended on interventions of determinants like conflicts, poverty and women education which are beyond the scope of this dissertation and men involvement in ANC, community based health insurance scheme, improving the skills and supportive supervision of health ANC providers; task shifting to lower cadres and further research.

Rapid cost-effectiveness analysis: hemodialysis versus peritoneal dialysis for patients with acute kidney injury in Rwanda

BackgroundTo ensure the long-term sustainability of its Community-Based Health Insurance scheme, the Government of Rwanda is working on using Health Technology Assessment (HTA) to prioritize its resources for health. The objectives of the study were to rapidly assess (1) the cost-effectiveness and (2) the budget impact of providing PD versus HD for patients with acute kidney injury (AKI) in the tertiary care setting in Rwanda.MethodsA rapid cost-effectiveness analysis for patients with AKI was conducted to support prioritization. An ‘adaptive’ HTA approach was undertaken by adjusting the international Decision Support Initiative reference case for time and data constraints. Available local and international data were used to analyze the cost-effectiveness and budget impact of peritoneal dialysis (PD) compared with hemodialysis (HD) in the tertiary hospital setting.ResultsThe analysis found that HD was slightly more effective and slightly more expensive in the payer perspective for most patients with AKI (aged 15–49). HD appeared to be cost-effective when only comparing these two dialysis strategies with an incremental cost-effectiveness ratio of 378,174 Rwandan francs (RWF) or 367 United States dollars (US$), at a threshold of 0.5 × gross domestic product per capita (RWF 444,074 or US$431). Sensitivity analysis found that reducing the cost of HD kits would make HD even more cost-effective. Uncertainty regarding PD costs remains.Budget impact analysis demonstrated that reducing the cost of the biggest cost driver, HD kits, could produce significantly more savings in five years than switching to PD. Thus, price negotiations could significantly improve the efficiency of HD provision.ConclusionDialysis is costly and covered by insurance in many countries for the financial protection of patients. This analysis enabled policymakers to make evidence-based decisions to improve the efficiency of dialysis provision.

A Hierarchical Bayesian approach to small area estimation of health insurance coverage in Ethiopian administrative zones for better policies and programs

Sample surveys are extensively used to provide reliable direct estimates for large areas or domains with enough sample sizes at national and regional levels. However, zones are unplanned domains by the Demographic and Health Survey (DHS) program and need more sample sizes to produce direct survey estimates with adequate precision. Conducting surveys in small areas (like zones) is too expensive and time-consuming, making it unfeasible for developing countries like Ethiopia. Therefore, this study aims to use the Hierarchical Bayes (HB) Small Area Estimation (SAE) model to estimate the Community-Based Health Insurance (CBHI) coverage at the zone levels in Ethiopia. To achieve this, we combined the 2019 Ethiopia Mini-Demographic and Health Survey (EMDHS) data with the 2007 population census data. SAE has addressed the challenge of producing reliable parameter estimates for small or even zero sample sizes across Ethiopian zones by utilizing auxiliary information from the population census. The results show that model-based estimates generated by the SAE approach are more accurate than direct survey estimates of CBHI. A map of CBHI scheme coverage was also used to visualize the spatial variation in the distribution of CBHI scheme coverage. From the CBHI scheme coverage map, we noticed notable variations in CBHI scheme coverage across Ethiopian zones. Additionally, this research identified areas with high and low CBHI scheme coverage to improve decision-making and increase coverage in Ethiopia. One of the novelties of this paper is estimating the non-sampled zones; therefore, the policymakers will give equal attention similar to the sampled zones.

Patterns of enrollment to community-based health insurance and the situations influencing utilization of the services in Southern Ethiopia: a qualitative study

Patterns of enrollment to community-based health insurance and the situations influencing utilization of the services in Southern Ethiopia: a qualitative study

Willingness-To-Pay for Health Insurance: Protocol for a Comparative Study Between Formal and Informal Health-Workers

INTRODUCTION People in low- to middle-income countries (LMICs), such as Bangladesh, have less access to healthcare than those in wealthier nations with less than 1% of the population having access to social health protection, which is mostly limited to those who work in the formal sector (14.9% of all jobs). This comparative study aims to use the contingent valuation method (CVM) to determine the factors affection and compare the mean willingness-to-pay (WTP) for community-based health insurance (CBHI) between formal and informal health workers. METHODS AND ANALYSIS This comparative study will be conducted among 250 doctors who will be selected by a convenience sampling technique from various formal and informal workstations in Dhaka City. Of the 250 participants, 125 will be from each group. To collect data, a semi-structured questionnaire will be used via face-to-face interviews. Data will be processed and analyzed using R (v4.3.0) and RStudio (v2023.03.1). WTP for CBHI will be estimated using the “DCchoice” package. The primary outcome is to estimate the proportion and mean WTP across the groups and compare it using double bound dichotomous choice (DBDC) method. Secondary outcomes include identifying the socio-demographic, job-related and healthcare seeking-related factors that influence the WTP. ETHICS AND DISSEMINATION Ethics approval has been obtained from Institutional Review Board (IRB) of the National Institute of Preventive and Social Medicine (NIPSOM). Informed consent will be taken from each participant before data collection. The results of the study will be published in scientific, peer-reviewed journals. STRENGTHS AND LIMITATIONS OF THIS STUDY – The contingent valuation method is a well-established method of eliciting WTP for health insurance. – The current study will be among the first of its nature as it will focus on formal and informal healthcare workers. – Starting point bias may affect the result as this type of bias comes with the Double bounded dichotomous choice (DBDC) method used in this study.

Barriers and facilitators of severe acute malnutrition management at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, North West Ethiopia, descriptive phenomenological study.

Malnutrition is a clinical condition that affects all age groups, and it remains a major public health threat in Sub-Saharan Africa. As a result, this research aimed to investigate the barriers and facilitators of treating severe acute malnutrition at Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar City, North West Ethiopia. A descriptive phenomenological study was conducted from February to April 2021. The final sample size taken was fifteen based on data saturation. In-depth and key informant interviews were conducted with nine caregivers, three healthcare workers, and three healthcare managers supported by observation. A criterion-based, heterogeneous purposive sampling technique was used to select the study participants. Each interview was audio-taped to ensure data quality. Thematic analysis was done to analyze the data using Atlas. ti version 7 software. Two major themes and six sub-themes emerged. Barriers related to severe acute malnutrition management include subthemes on socio-economic and socio-cultural conditions, perceived causes of severe acute malnutrition and its management, and the healthcare context. Facilitators of severe acute malnutrition management include severe acute malnutrition identification, service delivery, and being a member of community-based health insurance. Effective management of severe acute malnutrition was affected by a multiplicity of factors. The results reaffirm how socioeconomic and sociocultural conditions, perceived causes of severe acute malnutrition (SAM) and its management and the health care context were the major barriers, while able to identifying severe acute malnutrition, service delivery, and is a member of community-based health insurance were the major facilitators for SAM management. Therefore, special attention shall be given to SAM management.

Factors influencing delay in malaria treatment seeking at selected public health facilities in South Gonder, Ethiopia

Early and prompt treatment-seeking for malaria is necessary to reduce the progression of the disease to its severe forms and the associated mortality. Various studies have indicated that treatments sought for malaria were not always within the recommended timeframe. Therefore, this study aims to assess factors influencing delay in malaria treatment seeking at public health facilities in South Gonder, Ethiopia. An unmatched case–control study was conducted among 322 individuals, comprising 161 cases and 161 controls, who were randomly selected malaria patients visiting public health facilities in South Gonder District, Ethiopia, from May 20/2022 to June 25/2022. An interviewer-administered questionnaire was used to collect data, which were subsequently cleaned and entered into Epi data. Descriptive statistics were performed, and variables with a p-value of ≤ 0.25 from the bivariate analysis were included in a multivariable logistic regression model. Significant variables with a p-value of < 0.05 were retained in the multivariable model. Patients who were unable to read and write [AOR = 3.47 (1.01–11.9)], fear of side effects of malaria treatment drugs [AOR = 1.89 (1.04–3.42)], lack of access to health education malaria disease and its treatment [AOR = 1.93 (1.02–3.65)], lack of transportation access [AOR = 4.70 (1.73–12.7)], not membership of community-based health insurance [AOR = 2.5 (1.3–4.82)] and lack of confidence on malaria care health facility providing [AOR = 2.14 (1.06–4.29)], were found to be determinants of treatment-seeking delay among malaria patients. In Summary, this study revealed significant associations between delays in seeking malaria treatment and factors such as educational status (those who were unable to read and write), malaria drug side effects, health education on malaria, transportation access, CBHI membership, and confidence in health malaria care. it is recommended that targeted interventions and awareness campaigns be implemented to address these determinants, promoting prompt and effective malaria treatment-seeking behavior in the studied population.

'My feet cannot stand on their own': podoconiosis patient healthcare expenditures and income impacts in Rwanda.

Podoconiosis is a progressive and debilitating form of tropical lymphoedema endemic to Rwanda. Although the physical and psychological consequences are well known, few studies have evaluated the financial burden of podoconiosis. This cross-sectional, quantitative study aimed to characterize direct treatment costs and impacts on annual earnings among individuals living with podoconiosis. Participants from two highly endemic districts were invited to complete a survey focused on health-seeking history, insurance status, out-of-pocket costs and income changes. Direct treatment costs included medical expenditures (consultation, diagnostics, medication) and non-medical expenditures (food, transportation, accommodation). Overall, 226 adults (≥18y of age) diagnosed with podoconiosis participated. Most had access to community-based health insurance (91.6%) but were unable to work (71.7%). Respondents sought care from health centres/posts (61.9%), hospitals (25.1%), traditional healers (5.8%) and/or community health workers (4.0%). On average, study participants paid US$32.50 (range US$0-779.23) annually, or 11.7% of their household salary, on podoconiosis treatments. This study demonstrates the significant financial burden of podoconiosis on individuals and their communities. Increased attention on integrating podoconiosis management into primary care systems and testing cost-effective solutions is needed to protect those who are most vulnerable.

Exploring Factors Influencing Family's Enrollment in Community-Based Health Insurance in the City of Gondar Peri-Urban Community, Northwest Ethiopia: A Health Belief Model Approach.

A research gap exists in finding practical solutions to provide affordable and accessible health insurance coverage to improve CBHI enrollment and sustainability to people in resource-poor settings and contribute to achieving universal health coverage (UHC) in Ethiopia. This research was initiated to analyze the role of community trust in scheme management and health choice to identify significant factors based on the health belief model (HBM). This psychological framework explains and predicts health behavior by considering individual perceptions. Cross-sectional information was gathered from 358 families, and original facts were utilized. Descriptive data and the Binary logistics in the econometric model were applied for data analysis. The descriptive findings demonstrated that other variables were established to possess a significant consequence except for job and occupation variables. The results of the logistic regression model showed that the distance of the nearest health station from the family's home in a minute [AOR (95% CI) =0.177 (0.015, -0.399)], being a member of the families having an official position in local government or cultural structure [AOR (95% CI) =0.574 (0.355, 0.793)], having an experience of visiting health facilities [AOR (95% CI) =0.281 (0.166, 0.396)], and perceiving the local CBHI scheme management as trustworthy [AOR (95% CI) =0.404 (0.233, 0.575)] were positively associated with family enrollment in the CBHI scheme. On the other hand, being a member of the "rotating saving and credit association" (ROSCA) [AOR (95% CI) =-.299 (-.478, -0.120)] was negatively associated with the family's enrollment in the CBHI scheme. Trust in CBHI scheme management, family's experience of visiting health facilities, and distance from the nearest health station were essential factors influencing enrollment in CBHI schemes. "Rotating saving and credit association" (ROSCA) ° negatively and statistically significantly impacted the family's CBHI enrolment status. Income level was not associated with enrollment.

Combining social protection interventions for better food security: Evidence from female-headed households in Amhara region, Ethiopia.

Ethiopia introduced its flagship poverty-targeted social protection program, the Productive safety net program (PSNP), in 2005 and Community-Based Health Insurance (CBHI) in 2011. Although both programs operate in several districts with some overlaps, evidence is scarce on how these large-scale programs jointly affect the food security of vulnerable groups. This study examines the impacts of a combination of these programs on food security outcomes among female-headed households in a chronically food-insecure and drought-prone district. Cross-sectional data were collected from 365 female-headed households selected through multi-stage sampling technique and analyzed using Inverse-probability-weighted regression adjustment (IPWRA) strategy to assess the effect of the programs on food security. The results show that while 63.6% of sample households are enrolled in CBHI and 48.8% are beneficiaries of PSNP's conditional cash transfer (CCT) component, membership in both social protection programs was 38.9%. The IPWRA analysis finds that inclusion in the CCT combined with CBHI, on average, increased dietary diversity score by 0.918 (95% CI 0.779-1.057) and food consumption score by 0.576 (95% CI 0.464-0.688). It also reduced household food insecurity access scale by 8.658 (95% CI -9.775 - -7.541). In all assessments, a combination of CBHI and CCT always produced results of a larger magnitude than each of CBHI and CCT alone. The findings provide evidence of the potentials of integrating social protection programs to increase food security outcomes among the most vulnerable and marginalized groups in a developing country. In addition, the results have also useful implications to achieve sustainable development goals related to ending hunger and achieving food security among vulnerable groups.

Assessment of Health Seeking Behaviour of the Elderly in a Rural Community of Sokoto State, Nigeria

Introduction: The ageing populations of Nigeria has increased from 4.61% in 2020 to 4.78 % in 2022 and are vulnerable to long term diseases of insidious onset such as cardiovascular illness, Cerebrovascular accident (CVA), cancers, diabetes, and musculoskeletal disease. This study was carried out to assess the health problems of the elderly ad their health seeking behaviours. Materials and methods: This was cross-sectional descriptive study carried out amongst elderly persons aged 60 years and above in Wamakko Local Government Area of Sokoto state. Using a combination of multistage and systematic sampling methods, a total of 347 respondents were recruited into the study. A set of pretested questionnaire was used for data collection after obtaining ethical approval and informed consent from study subjects. Results: Less than half of the respondents (47.8%) had appropriate health seeking practices by visiting health facilities during spells of illness. The commonest illness experienced by the elderly in this community was musculoskeletal diseases followed by hypertension and visual problems. A total of 95.7% of the respondents were not covered with any form of health insurance scheme. Predictors of health seeking behavior included duration of illness more than ten years and belonging to upper socio-economic class. Conclusion: Very few of the elderly in this community had appropriate health seeking behavior with most of them not covered by any health insurance. There is the need to establish the community based health insurance scheme and bring on board all elderly persons so as to minimize out of pocket expenses by the aged.

What role does community-based health insurance play in the utilisation of health services among households in Ethiopia? A community-based comparative cross-sectional study

ObjectiveIn Ethiopia, despite increased health service coverage, health service utilisation remains very low. However, evidence on the level of health service utilisation between insured and non-insured households in the study...

Experiences of membership in munno mubulwadde (your friend indeed) - a novel community-based health insurance scheme in Luwero district in rural central Uganda

BackgroundCommunity-Based Health Insurance (CBHI) schemes are recognized as an important health financing pathway to achieving universal health coverage (UHC). Although previous studies have documented CBHIs in low-income countries, the majority of these have been provider-based. Non-provider based schemes have received comparatively less empirical attention. We sought to describe a novel non-provider based CBHI munno mubulwadde (your friend indeed) comprising informal sector members in rural central Uganda to understand the structure of the scheme, the experiences of scheme members in terms of the perceived benefits and barriers to retention in the scheme.MethodsWe report qualitative findings from a larger mixed-methods study. We conducted in-depth interviews with insured members (n = 18) and scheme administrators (n = 12). Four focus groups were conducted with insured members (38 participants). Data were inductively analyzed by thematic approach.ResultsMunno mubulwadde is a union of ten CBHI schemes coordinated by one administrative structure. Members were predominantly low-income rural informal sector households who pay annual premiums ranging from $17 and $50 annually and received medical care at 13 scheme-contracted private health facilities in Luwero District in Central Uganda. Insured members reported that scheme membership protected them from catastrophic health expenditure during episodes of sickness among household members, and especially so among households with children under-five who were reported to fall sick frequently, the scheme enabled members to receive perceived better quality health care at private providers in the study district relative to the nearest public facilities. The identified barriers to retention in the scheme include inconvenient dates for premium payment that are misaligned with harvest periods for cash crops (e.g. maize corn) on which members depended for their agrarian livelihoods, long distances to insurance-contracted private providers, falling prices of cash crops which diminished real incomes and affordability of insurance premiums in successive years after initial enrolment.ConclusionMunno mubulwadde was perceived by as a valuable financial cushion during episodes of illness by rural informal sector households. Policy interventions for promoting price stability of cash crops in central Uganda could enhance retention of members in this non-provider CBHI which is worthy of further research as an additional funding pathway for realizing UHC in Uganda and other low-income settings.

Enrollment and clients’ satisfaction with a community-based health insurance scheme: a community-based survey in Northwest Ethiopia

BackgroundAlthough the Ethiopian government has implemented a community-based health insurance (CBHI) program, community enrollment and clients’ satisfaction have not been well investigated in Gondar Zuria district, Northwest Ethiopia. This study assessed CBHI scheme enrollment, clients’ satisfaction, and associated factors among households in the district.MethodsA community-based cross-sectional survey assessed CBHI scheme enrollment and clients’ satisfaction among households in Gondar Zuria district, Northwest Ethiopia, from May to June 2022. A systematic random sampling method was used to select the study participants from eligible households. A home-to-home interview using a structured questionnaire was conducted. Data were analysed using the statistical packages for social sciences version 26. Logistic regression was used to identify variables associated with enrollment and clients’ satisfaction. A p-value < 0.05 was considered statistically significant.ResultsOut of 410 participants, around two-thirds (64.9%) of the participants were enrolled in the CBHI scheme. Residency status (AOR = 1.38, 95% CI: 1.02–5.32; p = 0.038), time taken to reach a health facility (AOR = 1.01, 95% CI: 1.00–1.02; p = 0.001), and household size (AOR = 0.77, 95% CI: 0.67–0.88; p < 0.001) were significantly associated with CBHI scheme enrollment. Two-thirds (66.5%) of enrolled households were dissatisfied with the overall services provided; in particular, higher proportions were dissatisfied with the availability of medication and laboratory tests (88.7%). Household size (AOR = 1.31, 95% CI: 1.01–2.24; p = 0.043) and waiting time to get healthcare services (AOR = 3.14, 95% CI: 1.01–9.97; p = 0.047) were predictors of clients’ satisfaction with the CBHI scheme services.ConclusionAlthough a promisingly high proportion of households were enrolled in the CBHI scheme, most of them were dissatisfied with the service. Improving waiting times to get health services, improving the availability of medications and laboratory tests, and other factors should be encouraged.

Determinants of community-based health insurance membership renewal decision among rural households in Kellem Wollega zone, Oromia regional state, Ethiopia: a community-based cross-sectional study.

Despite the fact that community-based health insurance (CBHI) is a promising program to achieve the goal of universal health coverage (UHC), it faces challenges that are not only due to low enrollment but also due to membership renewal decision that impact its sustainability. Hence, the study aimed to identify the determinants of CBHI membership renewal decision among rural households in Kellem Wollega zone, Ethiopia. The study was conducted in Kellem Wollega, Ethiopia, among rural households from March 30-April 30, 2022, using a community-based cross-sectional study design. An interviewer-administered structured questionnaire through face-to-face interviews was used. Using a systematic random sampling method, 551 households were selected making 540 (98%) response rates. The data was entered into EPI Data 3.1 and analyzed using SPSS 25 software. Descriptive statistics, binary, and multiple logistic regressions were performed. Using multiple logistic regressions, a significant association between the CBHI membership renewal decision and independent variables was identified, declaring the statistical significance level using a 95% confidence interval (CI) at p < 0.05. The overall rate of CBHI membership renewal decision among households was estimated to be 365 (67.6%, 95% CI = 63.7-71.5%). The factors that significantly influenced the households' membership renewal decision were family size (AOR = 0.46, 95% CI = 0.25-0.86), low literacy status (AOR = 0.28 95% CI = 0.12-0.64), lower than middle-level of wealth index (AOR = 9.80, 95% CI = 2.75-34.92), premium affordability (AOR = 4.34, 95% CI = 2.08-9.04), unavailability of services (AOR = 0.26, 95% CI = 0.12-0.55), trusting in health facilities (AOR = 5.81, 95% CI = 2.82-11.94), favorable providers' attitude toward members (AOR = 8.23, 95% CI = 3.96-19.64), good quality of service (AOR = 4.47, 95% CI = 2.28-8.85) and health care seeking behavior (AOR =3.25, 95% CI = 1.32-7.98). The overall CBHI membership dropout decision rate among rural households was high, which could affect health service provision and utilization. Therefore, the insurance scheme and contracted health facilities should consider and work on family size and wealth status when membership premiums are calculated, the education level of households when creating awareness about the scheme, building trust in the contracted health facilities by providing all promised benefit packages of health services with good quality, and improving the attitude of health care providers towards the scheme members.

The Paradox of the Ugandan Health Insurance System: Challenges and Opportunities for Health Reform.

For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda's health sector.

The sustainability of two departmental health insurance units in Senegal: A qualitative study

Despite decades of implementation, community-based health insurance (CBHI) in Africa has not effectively achieved Universal Health Coverage (UHC). As a response, from 2014 to 2017, a Belgian-Senegalese project organized an alternative solution: Departmental Health Insurance Units (UDAM). Professionals managed UDAMs at a departmental level, and healthcare providers charged a flat-rate fee. While research on sustainability is scarce in Africa, this study aims to understand the factors that explain why, four years after the end of the project, UDAMs are sustained. This qualitative research used Schell et al. (2013) conceptual framework on factors influencing sustainability. The data came from 13 months of field observations, a documentation review, 120 interviews at the local level and nine at the regional and national level, and a focus group. We carried out a thematic analysis according to the conceptual framework. The results show that central political support has strengthened over time. UDAMs have managed to stabilize their funding through State subsidies and social marketing strategies to improve membership. UDAMs kept their management fees at 13%, below the 25% standard proposed by the West African Economic and Monetary Union. Multiple partnerships have been established at international, national, and local levels. Building on the professionalization of its staff, UDAMs have strengthened their organizational capacity. Internal controls and a complaints system have been organized to improve UDAMs’ accountability. Many communication activities were carried out before the end of the project to prepare the exit strategy. With their extensive coverage (penetration rate over 60%), UDAMs impact the health system (between 2014 and 2021, they paid 2.5 million EUR to healthcare providers). Innovations have been implemented, such as organizing a group contribution based on collective work in fields of culture supported by the communities and local stakeholders. As part of its UHC strategy, Senegal decided at the end of 2022 to transition its 676 communal CBHI into 46 departmental units. The sustainability of two UDAMs has demonstrated the relevance of this model. However, sustainability can only be assured if the State prioritizes the health sector and donors place greater emphasis on alignment and sustainability. We need to study how it is organized to scale up nationally.

Psychosocial distress and associated factors among adult cancer patients at oncology: a case of Ethiopia.

Psychosocial distress is a chronic burden for cancer survivors, which impacts both their quality of life and their oncologic prognosis. Although the national cancer prevention and control program in Ethiopia has made efforts in cancer prevention, control, and management by implementing the national cancer control plan 2016-2020, there was no enough evidence about psychosocial distress among adult cancer patients. So, it is critical to understand the magnitude of psychosocial distress and the factors that contribute to it. The purpose of this study was to assess the prevalence of psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia. 2022. A multicenter institution-based cross-sectional study was conducted among a sample of 605 adult cancer patients from 30 April to 22 June 2022. A systematic random sampling technique was employed to select the study units. In addition, data were collected through interviewers administered questionnaires by using the validated and pretested tools. Distress was assessed using the Questionnaire on Stress in Cancer Patients Revised 10. Both bivariable and multivariable logistic regression was used to describe the association between dependent and independent variables. Independent variable with p < 0.25 in the bivariable logistic regression analyses were entered into multivariable logistic regression model. Variables with p < 0.05 in the multivariable logistic regression analyses were considered as statistically significant associated factors of psychosocial distress. A total of 593 adult cancer patients took part in this study with mean age of 46.86 ± 14.5 years. The overall prevalence of psychosocial distress was 63.74%. Variables such as being female [AOR = 1.98, 95% confidence interval (CI): 1.24-3.17], patients who lives in rural areas (AOR = 2.3, 95% CI: 1.49-3.54), community-based health insurance utilization (AOR = 0.34, 95% CI: 0.23-0.51), patients on chemotherapy treatment (AOR = 2.72, 95% CI: 1.38-5.39), patients with comorbidity (AOR = 3.2, 95% CI: 1.67-6.10), and symptom burdens such as severe fatigue (AOR = 1.65, 95% CI:1.09-2.39) and severe nausea (AOR = 2.07, 95% CI: 1.43-3.00) were statistically associated with psychosocial distress. In general, the findings of this study showed a relatively high magnitude in which around two-thirds of patients experienced psychosocial distress. It is better to establish and enforce the integration and coordination of psychosocial oncology service programs at national level with parallel guidelines and policies.

Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage.

The Government of Ethiopia (GoE) has made significant progress in expanding access to primary health care (PHC) over the past 15 years. However, achieving national PHC targets for universal health coverage will require a significant increase in PHC financing. The purpose of this study was to generate cost evidence and provide recommendations to improve PHC efficiency. We used the open access Primary Health Care Costing, Analysis, and Planning (PHC-CAP) Tool to estimate actual and normative recurrent PHC costs in nine Ethiopian regions. The findings on actual costs were based on primary data collected in 2018/19 from a sample of 20 health posts, 25 health centers, and eight primary hospitals. Three different extrapolation methods were used to estimate actual costs in the nine sampled regions. Normative costs were calculated based on standard treatment protocols (STPs), the population in need of the PHC services included in the Essential Health Services Package (EHSP) as per the targets outlined in the Health Sector Transformation Plan II (HSTP II), and the associated costs. PHC resource gaps were estimated by comparing actual cost estimates to normative costs. On average, the total cost of PHC in the sampled facilities was US$ 11,532 (range: US$ 934-40,746) in health posts, US$ 254,340 (range: US$ 68,860-832,647) in health centers, and US$ 634,354 (range: US$ 505,208-970,720) in primary hospitals. The average actual PHC cost per capita in the nine sampled regions was US$ 4.7, US$ 15.0, or US$ 20.2 depending on the estimation method used. When compared to the normative cost of US$ 38.5 per capita, all these estimates of actual PHC expenditures were significantly lower, indicating a shortfall in the funding required to deliver an expanded package of high-quality services to a larger population in line with GoE targets. The study findings underscore the need for increased mobilization of PHC resources and identify opportunities to improve the efficiency of PHC services to meet the GoE's PHC targets. The data from this study can be a critical input for ongoing PHC financing reforms undertaken by the GoE including transitioning woreda-level planning from input-based to program-based budgeting, revising community-based health insurance (CBHI) packages, reviewing exempted services, and implementing strategic purchasing approaches such as capitation and performance-based financing.