Community-based Health Insurance Research Articles

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

The 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. The 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. The 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). The 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).

The role of community-based health insurance on healthcare seeking behavior of households in Addis Ababa, Ethiopia

Community-based health insurance is a new and promising concept for delivering easily accessible, affordable, and efficient healthcare services. More importantly, a significant risk pooling arrangement between the wealthy and poor. So far, little has been done regarding community-based health insurance and healthcare seeking behavior in developing countries. Therefore, the aim of this study was to assess healthcare seeking behavior of households due to the introduction of the scheme and associated factors in Addis Ababa. Community-based cross-sectional study was conducted among 270 male and 207 female respondents. The data was collected using standardized and pretested questionnaire and it was analyzed using SPSS software. A bivariate and multivariable logistic regression analysis was applied to determine the relationship between healthcare seeking behavior and determinant variables. Finally, statistical association was declared with a p-value of less than 0.05 in the multivariable logistic regression analysis. The proportion of people who had appropriate healthcare-seeking behavior was 47.31% (95 %CI: 43.27–51.39%). Furthermore, having more than four children [AOR: 0.171, 95%, CI:(0.403–0.99)], being Muslim [AOR: 1.712, 95 %CI: (1.117 2.625)], owning a government house [AOR: 4.472, 95%, CI: (2.037–9.819)], and having under-five children [AOR: 0.548, 95%, CI: (0.375–0.801)] were factors significantly associated with healthcare-seeking behavior. Even though this study was conducted in an urban area, it showed that the magnitude of appropriate healthcare-seeking behavior was low. Therefore, the government of Ethiopia should work to improve housing conditions and family planning provision for the residents to improve the healthcare seeking behavior of community-based health insurance users.

Wealth Status and Health Insurance Enrollment in India: An Empirical Analysis.

Since 2005, health insurance (HI) coverage in India has significantly increased, largely because of the introduction of government-funded pro-poor insurance programs. As a result, the determinants of HI enrollment and their relative importance may have changed. Using National Family Health Survey (NFHS)-4 data, collected in 2015-2016, and employing a Probit regression model, we re-examine the determinants of household HI enrollment. Then, using a multinomial logistic regression model, we estimate the relative risk ratio for enrollment in different HI schemes. In comparison to the results on the determinants of HI enrollment using the NFHS data collected in 2005-2006, we find a decrease in the wealth gap in public HI enrollment. Nonetheless, disparities in enrollment remain, with some changes in those patterns. Households with low assets have lower enrollments in private and community-based health insurance (CBHI) programs. Households with a higher number of dependents have a higher likelihood of HI enrollment, especially in rural areas. In rural areas, poor Scheduled Caste and Scheduled Tribe households are more likely to be enrolled in public HI than the general Caste households. In urban areas, Muslim households have a lower likelihood of enrollment in any HI. The educational attainment of household heads is positively associated with enrollment in private HI, but it is negatively associated with enrollment in public HI. Since 2005-2006, while HI coverage has improved, disparities across social groups remain.

Willingness to join social health insurance and community-based health insurance among rural residents in Akwa Ibom state, Nigeria

Background: Universal Health Coverage seeks to ensure that all individuals have equitable access to quality health care with limited exposure to financial risk. Pooling of community members into health insurance schemes is necessary for the achievement of UHC. Most rural dwellers do not have health insurance and are susceptible to catastrophic health expenditure.
 Objective: This study aims to determine the willingness of rural dwellers in Akwa Ibom state, Nigeria, to join health insurance schemes.
 Methods: The study was conducted in three local government areas in Akwa Ibom State, Nigeria. It was a cross-sectional study with multi-stage data collection. Participants were 286 household heads. Data analysis was done using SPSS version 22 (New York), and statistical significance was set at 0.05.
 Result: Majority of the household heads were 31-60years (71.0%), male (71.7%), had attained secondary education (43.0%), earned less than ₦20,000 (79.7%) and had spouses who earned less than ₦20,000 (72.0%). Only 30.1% had heard of health insurance, 2.5% belonged to a health insurance scheme. Majority of the respondents were willing to join a scheme, however, more participants were willing to join the proposed social insurance scheme (72.4%) than the community-based scheme (63.3%). Lack of funds and lack of trust were major barriers to joining a scheme. Frequency of illness was the only significant predictor of WTJ SHI (r= 0.141), while gender (r=0.186), educational level(r= -0.163), frequency of illness(r=0.142) and borrowing money for treatment(r=0.138) were significant predictors of WTJ CBHIS.
 Conclusion: The study found low awareness of health insurance. There was high level of willingness to join the proposed health insurance schemes. Those not willing to join cited unaffordability as the major barrier to joining the schemes. We recommend increased awareness about health insurance schemes and policy makers should design schemes that will empower rural residents to uptake health insurance to achieve the goals of Universal Health coverage.

The feasibility analysis of integrating community-based health insurance schemes into the national health insurance scheme in Uganda.

Uganda has a draft National Health Insurance Bill for the establishment of a National Health Insurance Scheme (NHIS). The proposed health insurance scheme is to pool resources, where the rich will subsidize the treatment of the poor, the healthy will subsidize the treatment of the sick, and the young will subsidize the treatment of the elderly. However, there is still a lack of evidence on how the existing community-based health insurance schemes (CBHIS) can fit within the proposed national scheme. Thus, this study aimed at determining the feasibility of integrating the existing community-based health financing schemes into the proposed National Health Insurance Scheme. In this study, we utilized a multiple-case study design involving mixed methods. The cases (i.e., units of analysis) were defined as the operations, functionality, and sustainability of the three typologies of community-based insurance schemes: provider-managed, community-managed, and third party-managed. The study combined various data collection methods, including interviews, survey desk review of documents, observation, and archives. The CBHIS in Uganda are fragmented with limited coverage. Only 28 schemes existed, which covered a total of 155,057 beneficiaries with an average of 5,538 per scheme. The CBHIS existed in 33 out of 146 districts in Uganda. The average contribution per capita was estimated at Uganda Shillings (UGX) 75,215 = equivalent to United States Dollar (USD) 20.3, accounting for 37% of the national total health expenditure per capita UGX 51.00 = at 2016 prices. Membership was open to everyone irrespective of socio-demographic status. The schemes had inadequate capacity for management, strategic planning, and finances and lacked reserves and reinsurance. The CBHIS structures included promoters, the scheme core, and the community grass-root structures. The results demonstrate the possibility and provide a pathway to integrating CBHIS into the proposed NHIS. We however recommend implementation in a phased manner including first providing technical assistance to the existing CBHIS at the district level to address the critical capacity gaps. This would be followed by integrating all three elements of CBHIS structures. The last phase would then involve establishing a single fund for both the formal and informal sectors managed at the national level.

Level of shared decision making and associated factors among patients with mental illness in Northwest Ethiopia: Explanatory sequential mixed method study.

Shared decision-making is a patient-centered and a recovery-oriented mental health system in which consumers are encouraged to actively engage in illness management. Although shared decision-making research in mental health has evolved rapidly in the past two decades, there is a lack of studies examining the level and factors associated with shared decision-making practice in low-income countries like Ethiopia. An institutional-based explanatory sequential mixed method study design was conducted from July 18 to September 18, 2022, at Bahir Dar city specialized hospitals. A systematic random sampling technique was used. The level of shared-decision making was measured by 9-item shared decision-making questionnaire among 423 patients with mental illness. Epicollect5 was used to collect data, which was then exported to the Statistical Package for social science version 25 for analysis. Variables with a P-value < 0.25 were considered candidates for the multivariate logistic regression analysis. The odds ratio with a 95% confidence interval was used to show the strength of the association. An in-depth interview was conducted among ten purposively selected participants. Low shared decision-making practice was found to be 49.2% (95% CI 45.9%-55.7%). The Multivariate analysis showed that low perceived compassionate care (AOR = 4.45; 95%CI 2.52-7.89), low social support (AOR = 1.72; 95% CI 1.06-2.80), and no community-based health insurance (AOR = 1.96; 95%CI l.04-3.69) were positively associated with low shared decision making. The qualitative result showed that the most common barriers to shared decision-making were a lack of empathy and a shortage of mental health workers. Almost half of the patients had low shared decision-making practices. This implies that shared decision-making requires high attention as it is essential for patient-centered care.

Household heads satisfaction and associated factors on community-based health insurance scheme in Gudeya Bila District, Oromia, Ethiopia.

Community-Based Health Insurance (CBHI) scheme refers to a non-profit type of health insurance for the informal sector. There is a paucity of information on this topic in Gudeya Bila, Ethiopia. This study aimed to assess the level of household (HH) satisfaction with the CBHI scheme and its associated factors. A community-based cross-sectional study design was employed from November 1-30, 2020, and a sample of 630 HHs who enrolled in the CBHI scheme were included. A multi-stage sampling and systematic random sampling were employed. Data was entered into Epidata version 3.1 and analyzed using SPSS for windows program version 25. A 95% CI was calculated and variables having p-value < 0.05 were considered statistically significant. Descriptive statistics, bivariate, and multivariable logistic regression analyses were performed. All HHs heads (630) with a response rate of 100% were involved in the study. The overall HH satisfaction on CBHI was 56.2%. Attending CBHI scheme-related meetings (AOR = 1.948, 95% CI = 1.16-3.27), healthcare provider respectfulness (AOR = 9.209, 95% CI = 2.73-31.06), able to get the ordered laboratory test service (AOR = 2.143, 95% CI = 1.127-4.072) and having paid extra money for drug supply at private health facilities (AOR = 0.492, 95% CI = 0.285-0.847) were independent predictors. HH satisfaction level on CBHI scheme was moderate. Attending CBHI scheme-related meetings, health-care provider respectfulness, being able to get the ordered laboratory test services and extra payments for drug supply were significant predictors of satisfaction with CBHI. Therefore, attention should be given to increasing the satisfaction of HHs with CBHI through improving the quality of health services.

Household satisfaction with a pilot community-based health insurance scheme and associated factors in Addis Ababa.

Many countries introduce CBHI as their healthcare financing system to ensure healthcare access. Understanding the level of satisfaction and factors associated with it is essential to ensure the sustainability of the program. Therefore, this study aimed to assess household satisfaction with a CBHI scheme and its associated factors in Addis Ababa. Institutional-based cross-sectional study was conducted in the 10 health centers found in the 10 sub-cities of Addis Ababa. Both quantitative and qualitative methods were used. Logistic regression analysis was carried out to identify its associated factors and thematic analysis was used for qualitative data. Finally, variables with a p-value of <0.05 have been considered statistically significant. In this study, the overall satisfaction level of households with CBHI was 46.3%. Satisfaction was associated with valid CBHI management regulations (AOR = 1.96, 95% CI: 1.12, 3.46), participants who received the right drug (AOR = 1.77, 95% CI: 1.08, 2.93), households who got immediate care (AOR = 4.95, 95% CI: 2.72, 8.98), those who agreed with the adequacy of medical equipment (AOR = 1.65, 95% CI: 1.02, 2.69), and households who agreed with qualification of health personnel (AOR = 1.89, 95% CI: 1.12, 3.20) were more satisfied with the scheme than their counterparts. The challenges mentioned by the discussants were the shortage of drugs, poor attitude of health professionals, absence of kenema pharmacy, lack of laboratory services, lack of awareness about the CBHI scheme, and tight payment schedule. the satisfaction level of households was low. To achieve a better result, the concerned bodies should work to improve the availability of medication, and medical equipment and improve the attitude of healthcare workers.

Enrollment of reproductive age women in community-based health insurance: An evidence from 2019 Mini Ethiopian Demographic and Health Survey.

Universal health coverage (UHC) is aimed at ensuring that everyone has access to high-quality healthcare without the risk of financial ruin. Community-based health insurance (CBHI) is one of the essential means to achieve the sustainable development goals (SDGs) global health priority of UHC. Thus, this study assessed health insurance enrollment and associated factors among reproductive age women in Ethiopia. We computed the health insurance enrollment of reproductive-age women using secondary data from the recent Ethiopian Mini Demographic and Health Surveys (EMDHS) 2019. The EMDHS was a community-based cross-sectional study carried out in Ethiopia from March 21 to June 28, 2019. Cluster sampling with two stages was employed for the survey. The study comprised 8885 (weighted) reproductive-age women. STATA 14 was used for data processing and analysis. Bivariate and multivariable logistic regression analyses were conducted. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported and statistical significance was set at a value of p < 0.05. Of the 8,885 study participants, 3,835 (43.2, 95% CI; 42.1, 44.2%) of women had health insurance. Women aged 20-24 years, 25-29 years, and 30-34 years less likely to enroll in health insurance compared to their younger counterparts (15-19 years). Women living in rural areas, had greater than five family sizes, living with a female household head, and having more than five living children were negatively associated with enrollment in health insurance. Besides, health insurance enrollment among reproductive-age women is significantly affected by region and religious variation. The overall CBHI enrolment among reproductive-age women in Ethiopia was low. To achieve the SDGs of reducing maternal mortality ratio and neonatal mortality, improving reproductive-age women's access to health insurance is essential. The national, regional, and local officals, policymakers, NGOs, program planners, and other supporting organizations working on improving health insurance enrollment of reproductive age women need to create awareness and support them based on these significant factors.

Catastrophic health expenditure and associated factors among households of non community based health insurance districts, Ilubabor zone, Oromia regional state, southwest Ethiopia

BackgroundOut-of-pocket health expenditure is the proportion of total health expenditure that is paid by individuals and households at the time of health service. Hence, the objective of this study is to assess the incidence and intensity of catastrophic health expenditure and associated factors among households in non-community-based health insurance districts in the Ilubabor zone, Oromia National Regional State, Ethiopia.MethodA community-based cross-sectional study design was employed in the Ilubabor zone on non-community-based health insurance scheme districts from August 13 to September 2, 2020, and 633 households participated in the study. A multistage one cluster sampling method was used to select three districts out of seven districts. Data was collected by using a structured mix of open and close-ended pre -tested questionnaires by face-to-face interviewing. A micro-costing/bottom up approach was used for all household expenditure. After checking its completeness, all household consumption expenditure was done by mathematical analysis using Microsoft Excel. Binary and multiple logistic were done using 95%CI and significance was declared at P < 0.05.ResultsThe number of households that participated in the study was 633, with a response rate of 99.7%. Out of 633 households surveyed, 110 (17.4%) were in catastrophe, which exceeds 10% of total household expenditure. After medical care expenses, about 5% of the households moved downward from the middle poverty line to extreme poverty. Out-of-pocket payment AOR: 31.201: 95% CI (12.965–49.673), daily income less than 1.90 USD AOR: 2.081: 95% CI (1.010–3.670), living a medium distance from a health facility AOR: 6.219: 95% CI (1.632–15.418), and chronic disease AOR: 5.647: 95% CI (1.764–18.075.ConclusionIn this study, family size, average daily income, out of pocket payment and chronic diseases were statistically significant and independent predictors for household catastrophic health expenditure. Therefore, to overcome financial risk, the Federal Ministry of Health should develop different guidelines and modalities by considering household per capita and income to improve the enrolment of community-based health insurance. Also, the regional health bureau should improve their budget share of 10% to increase the coverage of poor households. Strengthening financial risk protection mechanisms, such as community-based health insurance, could help to improve healthcare equity and quality.

Households’ Willingness to Pay for Community-Based Health Insurance in the Southwest Region of Bangladesh

In Bangladesh, especially the informal sector workers are deprived of proper healthcare owing to high cost and lack of security like health insurance. The study aims to estimate the willingness to pay (WTP) of the informal sector workers for premium-based health insurance on the basis of data collected from 210 households, where double bounded dichotomous choice (DBDC) model was applied. The study estimates that this working-class people are willing to pay a monthly premium of on average around BDT (Bangladeshi Taka) 315 (USD 3.66) in response to enjoy the facilities of health insurance scheme for a household comprising up to four family members. Moreover, the per household estimated average monthly optimum tariff rate of almost BDT 300 (USD 3.54) and monthly mean social optimum tariff rate of about BDT 100 (USD 1.18) indicate the assurance of socially desirable welfare for all of the market participants. By charging this tariff, approximately 97 percent of the people would enjoy access to community-based health insurance, in addition to generating revenue that is around 1.13 times the project’s cost. Even by charging this monthly mean social optimum tariff, approximately 97 percent of the households would enjoy the access to community-based health insurance; the generating revenue through that tariff rate is around 1.13 times of the probable cost for high service package health scheme. In order to alleviate the burden of the out-of-pocket (OOP) costs for this vulnerable community, the study advises policymakers to initiate health insurance scheme by maintaining effective supervision over market dynamics and fixing the best fit premium rate.

Predictors of Under-Five Caregivers' Utilization of Co-Packaged Zinc and Oral Rehydration Salts for Childhood Diarrhea in East Wollega Zone, Western Ethiopia.

Diarrhea morbidity and mortality remain child health and economic burdens in low resource settings. In Ethiopia, diarrheal disease treatment service utilization remains very low. However, evidence on the level of utilization of zinc bundled with ORS among under-five caregivers' was not addressed. The study aimed to identify predictors of under-five caregivers' utilization of co-packaged zinc and oral rehydration salts for childhood diarrhea in East Wollega Zone, Western Ethiopia, in 2022. The study design used was a community-based cross-sectional study that was conducted among 540 randomly selected participants from April 1 to 30, 2022. Data were collected using interviewer-administered semi-structured questionnaires. It was entered into Epi-data version 3.1 and analyzed using SPSS version 26. An adjusted odds ratio along with a 95% confidence level was estimated, and a P value <0.05 was considered to declare the statistical significance in the multivariable analysis. About 39.6% of under-five caregivers' had utilized co-packaged zinc and oral rehydration salts for their childhood diarrhea at least once in the last 12 months. Having family size less than 5 [AOR and 95% CI = 5.72 (2.93,11.15)]; heard about the co-pack [AOR and 95% CI = 9.52 (4.95,23.68)]; perceived health status for the recent episode as poor [AOR and 95% CI = 5.90 (2.58, 15.96)] and medium [AOR and 95% CI = 2.20 (1.02, 4.83)]; perceived severity for recent episodes [AOR and 95% CI = 4.48 (1.36, 14.76)] and being community-based health insurance non-member [AOR and 95% CI = 2.28 (1.34, 6.90)] were statistically associated with co-packaged zinc and ORS utilization. The study found that co-packaged zinc and oral rehydration salt utilization was low. Family size, heard about the co-pack, perceived health status, perceived severity, and CBHI membership were predictors of co-packaged utilization of zinc and ORS. Hence, concerned bodies in the health system should have devoted to maximize its uptake.

Effect of community-based health insurance on catastrophic health expenditure among chronic disease patients in Asella referral hospital, Southeast Ethiopia: a comparative cross-sectional study

BackgroundChronic disease-related catastrophic health spending is frequent in Ethiopia affecting several households, particularly the poorest ones. A community-based health insurance (CBHI) scheme has been in place in Ethiopia since 2011. The scheme aims to provide financial protection against health expenditure but there is little evidence of how well it protects chronic patients financially.ObjectiveThe objective of the study was to evaluate the effect of community-based health insurance in reducing the incidence of catastrophic health expenditure among patients attending chronic disease follow-up departments in Asella referral hospital, Southeast Ethiopia.MethodA health facility-based comparative cross-sectional study was conducted in Asella referral hospital from March 2022 to May 2022. Systematic random sampling was used to select 325 chronic patients. Data were collected using an open data kit (ODK) collect app and then imported to STATA version 16 for analysis. Propensity score matching was used to evaluate the effect of community-based health insurance on catastrophic health expenditure.ResultThe study enrolled a total of 325 chronic patients (157 insurance members and 168 nonmembers). More than 30% of the study participants incurred health spending that could be catastrophic based on the 15% nonfood threshold. Catastrophic health expenditure was found in 31% of insured and 47% of uninsured participants. Overshoot and mean positive overshoot were 10% and 33% for insured members, respectively and the corresponding figures were 18% and 39% for nonmembers. Community-based health insurance contributes to a 19% ((ATT = -0.19, t = -2.97)) reduction in the incidence of catastrophic health expenditure among chronic patients. This result is found to be consistent for alternative measurements of the outcome variable and the use of alternative matching algorithms.ConclusionChronic patients, particularly those in uninsured households, had a high incidence and intensity of catastrophic health expenditure. Hence, it is relevant to expand community-based health insurance to provide financial protection for people suffering from chronic conditions.

In Ethiopia's Kutaber district, does community-based health insurance protect households from catastrophic health-care costs? A community- based comparative cross-sectional study.

Every health system needs to take action to shield households from the expense of medical costs. The Ethiopian government implemented community-based health insurance (CBHI) to protect households from catastrophic health care expenditure (CHE) and enhance the utilization of health care services. The impact of CBHI on CHE with total household expenditure and non-food expenditure measures hadn't been studied, so the study aimed to evaluate the impact of CBHI on CHE among households in Kutaber district, Ethiopia. A total of 472 households (225 insured and 247 uninsured) were selected by multistage sampling techniques. Households total out-of-pocket (OOP) health payments ≥10% threshold of total household expenditure or ≥40% threshold of household non-food expenditure categorized as CHE. The co-variants for participation in the CBHI scheme were estimated by using a probit regression model. A propensity score matching analysis was used to determine the impact of CBHI on CHE. A Chi-square (χ2) test was computed to compare CHE between insured and uninsured households. The magnitude of CHE was 39.1% with total household expenditure and 1.8% with non-food expenditure measures among insured households. Insured households were 46.3% protected from CHE when compared to uninsured households with total household expenditure measures and 24.2% to 25% with non-food expenditure measures. The magnitude of CHE was lower among CBHI-enrolled households. CBHI is an effective means of financial protection benefits for households as a share of total household expenditure and non-food expenditure measures. Therefore, increasing the upper limits of benefit packages, minimizing exclusions, and CBHI scale-up to uninsured households is essential.

Health-Related Quality of Life between Insured and Uninsured Households at Rural Communities of Southwestern Ethiopia: A Comparative Cross-Sectional Study

Background. Community-based health insurance (CBHI) is one of the strategies among others to be used for the achievement of universal health coverage (UHC) through providing financial protection to the citizens of a country. The schemes have been seen as effective in reducing out-of-pocket (OOP) payments and improving access to the healthcare services. This study tried to assess health-related quality of life between members and nonmembers of the scheme in rural southwest Ethiopia. Study Method. A community-based comparative cross-sectional study was conducted between the insured and uninsured populations. A standardized WHOQOL-BREF questionnaire was used. Cross-tab and frequency table analysis were done to tabulate for monovariable and bivariable analysis. Multiple linear regressions were employed to determine associations by adjusting for potential confounders. The association decision was made after fitted assumptions and adjustments done by modeling. Results. About six hundred thirty-four (634) households completed the survey with a response rate of 97.2%. More than 90% of the participants were illiterate and elementary education completed and farmers. Most uninsured family members claimed that they had difficulty affording annual payments 72.5%, P &lt; 0.001. Willingness to pay was higher for insured members of households (72.2%), P &lt; 0.001. Being insured had experienced a higher quality of life than uninsured, β (95% CI), 4.15 (2.52, 5.77), and P &lt; 0.001. Marital status other than married had lower quality of life experiences than married alone, β (95% CI), −6.83 (−9.75, −3.92), and P &lt; 0.001. Male respondents were experiencing lower quality than females, β (95% CI), −2.49 (−4.25, −0.72), and P = 0.006. Family number of the household and quality of life had positive linear relations, β (95% CI), 0.87 (0.43, 1.31), P &lt; 0.001. Conclusions and Recommendations. Being insured had positive implications for quality of life. Inhabitants have to be encouraged to the scheme membership.

Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal.

The turn towards Universal Health Coverage (UHC) in the past decade raises the question of the role of the state, following years of state withdrawal and a fragmented approach to public health. Senegal introduced its version of UHC, Couverture Maladie Universelle (CMU) in 2013 and this paper explores early efforts to fund it through the establishment of community-based health insurance (CBHI). The paper draws on ethnographic research at mutual health organisations, or mutuelles de santé as they are commonly referred to in francophone countries, which manage CBHI. The research was carried out as part of broader doctoral fieldwork on poverty and social protection in the capital, Dakar, in 2017-18. Responding to recent calls for the move away from the voluntary nature of CBHI with government subsidies and the professionalisation of management, this paper considers the financial strain that mutuelles were under. By drawing on the concept of 'improvisation' as it has come to be employed in recent ethnographies of health infrastructure in contexts of scarcity, the paper attends to the ways in which mutuelles and the voluntary workers that run them sought alternative forms of support, with a particular focus on patronage and partnership. I argue that what might appear to be very minimal gestures of support and material investment serve to maintain a sense of hope and potential in CMU, one however that is fragile and potentially unsustainable.

The Impact of Health Maintenance Organizations in the Implementation of the Nigeria National Health Insurance Scheme in the Federal Capital Territory (Abuja), Nigeria.

The activities of Health maintenance organizations (HMO) are central to the achievement of universal health coverage. This study sought to examine the number of HMOs actively operating in the FCT and to determine whether the HMOs are promoting or inhibiting universal coverage and proffer recommendations for the overall progress of the scheme. A descriptive prospective cross-sectional study design was used and mixed (qualitative and quantitative) methods A pre-tested interviewer-administered questionnaire make was used to collect quantitative data while qualitative data were collected through a review of literature and in-depth interviews to examine the roles of HMOs from stakeholders' points of view. A total of 250 participants comprised predominantly 230 enrollees into three major programs of the NHIS that is the formal sector social insurance program (FS-SHIP), tertiary institution social health insurance program (TI-SHIP), and community-based social health insurance program (CB-SHIP). The remaining 20 (twenty) enrollees comprised NHIA desk officers, HMO managers, community-based representatives, and healthcare providers. The majority of the respondents (64.8%) reported a high level of awareness of the knowledge of NHIS, while fewer than 19% indicated a lack of awareness as compared to 17% who did not respond to the question. Similarly, most of the respondents (62.2%) reported having satisfactory knowledge of the structure-function modalities of HMOs, while 20.4% were not aware of the mode of operation of HMOs.Contrasting contributions of HMOs to NHIS implementation, approximately half of the respondents (50%) reported dissatisfaction. Likewise, about 50% of the study subjects were of the view that HMOs are not putting the desired commitment towards achieving this goal of universal health coverage. The report from the in-depth interview reiterated that the enrollees were not well satisfied due to the perceived poor and inadequate operational mechanisms of both the HMOs and NHIS. The study revealed a high level of awareness of the knowledge of NHIS and good working knowledge of the structure and function of the HMOs. However, this study demonstrated a low understanding of the working interactions between the NHIS and HMO, among the respondents. Understanding HMOs and how they work is critical for choosing a health plan during open enrollment, hence, there is a need for more client enlightenment.

DIGITALIZING COMMUNITY-BASED HEALTH INSURANCE IN ETHIOPIA

Background: It is the plan of the Ethiopian government in order to digitalize the health care system. Though the digitalizing of the health care system in the country is at its infant stage and some of the projects fail. Different challenges have contributed to this low implementation of ICT in most Ethiopian healthcare systems. Methodology: This study is a systematic type of review and the major source of articles used in this study were searched from databases such as PubMed, Scopus Google, Google Scholar, and other online databases. This study included eight studies that state the ICT implementation and related challenges in the health care system and community-based health insurance (CBHI). Results: This study has identified 14 challenges to implementing ICT in the Ethiopian Health care system Age, educational status, computer access, personal initiation, infrastructure, computer skill, poor internet connection, budget shortage and management style, workload, patient interaction, Lack of e-government readiness, absence of multi-sectorial involvement and lack of enabling policies. Conclusion: This systematic review study underlined that poor ICT infrastructure, lack of computer skills, shortage of budget, Management style and lack of enabling policies were the most common challenges in the implementation of ICT in the Ethiopian health care system.

On the functioning of community-based health insurance schemes in rural Ethiopia

On the functioning of community-based health insurance schemes in rural Ethiopia

Determinants of trust in healthcare facilities among community-based health insurance members in the Manna district of Ethiopia

BackgroundLow-income countries, including Ethiopia, face substantial challenges in financing healthcare services to achieve universal health coverage. Consequently, millions of people suffer and die from health-related conditions. These can be efficiently managed in areas where community-based health insurance (CBHI) is properly implemented and communities have strong trust in healthcare facilities. However, the determinants of community trust in healthcare facilities have been under-researched in Ethiopia.ObjectiveTo assess the determinants of trust in healthcare facilities among community-based health insurance members in the Manna District of Ethiopia.MethodsA community-based cross-sectional study was conducted from March 01 to 30, 2020 among 634 household heads. A multistage sampling technique was used to recruit the study participants. A structured interviewer-administered questionnaire was used to collect the data. Descriptive statistics were computed as necessary. Multivariable linear regression analyses were performed, and variables with a p-value < 0.05 were considered to have a significant association with households’ trust in healthcare facilities.ResultsIn total, 617 households were included in the study, with a response rate of 97.0%. Household age (ß=0.01, 95% CI:0.001, 0.0013), satisfaction with past health services (ß=0.13, 95% CI:0.05, 0.22), perceived quality of services (ß= -0.47, 95% CI: -0.64, -0.29), perceived provider’s attitude towards CBHI members (ß = -0.68, 95% CI: -0.88, -0.49), and waiting time (ß= -0.002, 95% CI:- 0.003, -0.001) were determinants of trust in healthcare facilities.ConclusionThis study showed that respondents’ satisfaction with past experiences, older household age, long waiting time, perceived poor quality of services, and perceived unfavorable attitudes of providers towards CBHI members were found to be determinants of trust in healthcare facilities. Thus, there is a need to improve the quality of health services, care providers’ attitudes, and clients’ satisfaction by reducing waiting time in order to increase clients’ trust in healthcare facilities.