Community-based Health Insurance Research Articles

Community-based health insurance beneficiaries' satisfaction on laboratory services and associated factors in selected public hospitals in Jimma Zone, Oromia Region, Southwest, Ethiopia.

The community-based health insurance (CBHI) scheme is a growing initiative aimed at enhancing healthcare access for the most impoverished members of the community. The Ethiopian CBHI scheme aims to enhance access to essential healthcare services, including medical laboratory services, for the poorest members of the community, but there is limited evidence on satisfaction levels. The aim of this study was to assess the satisfaction level of CBHI beneficiaries with laboratory services and their associated factors among selected public hospitals in Jimma Zone, Oromia Region, Ethiopia. A facility-based cross-sectional study was conducted on selected public hospitals in the Jimma Zone from September to October 2023. A total of 421 CBHI beneficiaries were enrolled in the study using a convenient sampling technique, and interviewers administered structured questionnaires to collect data. Data were entered into Epi-data and analyzed using the Statistical Package of Social Sciences version 25. Descriptive analysis was used to summarize independent variables; bivariate and multivariable logistic regression analyses were done to test the association between independent and dependent variables; and statistical significance was declared at P<0.05. More than half (55.8%) of the 419 study participants were female. Above half, 57.5% of the respondents were satisfied by the clinical laboratory services at public hospitals in Jimma Zone. Components with a higher satisfaction rate were providers' professional appearances (98.3%), procedures for specimen collection (87.6%), and availability of entertainment facilities at the waiting area (67.8%). On the contrary, longer waiting times to receive the test results (76.6%), inefficiency of the reception area (74.7%), and the inability of professionals to explain diagnostic procedures (58.0%) were associated with higher rates of dissatisfaction. Educational status and the number of hospital visits were found to have a statistically significant association with level of satisfaction with laboratory services. CBHI beneficiaries' satisfaction with laboratory service was at a moderate level in Jimma Zone public hospitals. Therefore, attention should be given to continuous monitoring of patients' satisfaction with services, improving reception areas, and practicing routine explanations about the purposes and procedures during specimen collection to improve the beneficiaries' satisfaction level with clinical laboratory services.

Satisfaction of chronic patients with community-based health insurance schemes and related factors: Explanatory sequential mixed methods study.

Chronic disease poses a serious threat to accessible, high-quality healthcare. Community-based health insurance (CBHI) schemes provide the poor with financial security. However, there is no evidence in Ethiopia on how satisfied chronic patients are with the schemes. The objective of the current study was to evaluate the satisfaction of chronic patients with the schemes and identify contributing factors. A hospital-based explanatory sequential mixed methods study on 632 chronic patients and 12 key informants was carried out between February 28 and May 31, 2022, in the hospitals of East Gojjam, Northwest Ethiopia. Hospitals and study participants were selected using multistage sampling methods. Quantitative data was entered using Epi Data 3.1 and exported to SPSS version 25 for analysis. P value <0.05 was used to consider significant association in multivariable binary logistic regression. Thematic analysis was a method to manually review qualitative data. A narrative approach was used for integrating the two data. The mean age of study participants was 46.1 (46.1± 5.2, range: 25-82). Patients aged 45 to 64 made up the majority of the population (60.6%). Rheumatoid arthritis affected the preponderance of individuals (36.4%). The overall level of satisfaction of chronic patients with the CBHI scheme was 31% (95% CI; 27-35%). Respect and friendliness (AOR = 7.05; CI: 3.71-13.36), knowledge of benefits packages (AOR = 2.02; CI: 1.24-3.27), partial or non-availability of drugs (AOR = 0.24, AOR = 0.21, respectively), waiting times (AOR = 1.84; CI: 1.12-3.0), and availability of laboratory tests (AOR = 1.59; CI: 1.01-2.48) were significantly associated with participants' satisfaction with the schemes. Our study revealed that the overall satisfaction of chronic patients was quite low and affected by the availability of drugs and laboratory tests, caregivers' respect and friendliness, waiting times, and participant knowledge. Therefore, stakeholders must concentrate on reducing waiting times, improving the availability of drugs and laboratory tests at each hospital, opening back up community pharmacies, and promoting awareness about benefits packages primarily through health education. The main focus of researchers needs to be on nationally representative studies that include more important factors.

Proportion and factors influencing healthcare-seeking behavior among older people in Motta town, East Gojjam: a community-based cross-sectional study, Ethiopia, 2023

BackgroundIn resource-limited countries, older people who are at risk and face numerous health problems, often receive insufficient attention regarding their healthcare-seeking behavior. Assessing the proportion of healthcare-seeking behavior and associated factors among older people in Motta town, was the aim of the study.MethodA community-based cross-sectional study was carried out from April 22 to May 22, 2023. The study subjects were chosen using a systematic random sampling technique. To identify candidate variables for multivariable analysis, a bivariable logistic regression analysis was performed. Variables having a P-value of < 0.05 were considered statistically significant.ResultsFrom the total, 161 (39.3%) of respondents had good healthcare-seeking behavior with 95% CI [35%, 44%]. Secondary school [AOR = 2.69, 95% CI = 1.27, 5.68], Education college and above [AOR = 4.6, 95% CI = 2.27, 9.33], Family support during their illness [AOR = 1.39, 95% CI = 1.05, 3.09], Members of CBHI [AOR = 2.02, 95% CI = 1.21, 3.36], and presence of chronic illness [AOR = 2.55, 95%, CI = 1.64, 3.97] were significantly associated with good healthcare-seeking behavior.Conclusion and recommendationThis study found that good healthcare-seeking behavior among older people is significantly associated with higher education, strong family support, Community-Based Health Insurance (CBHI) membership, and chronic illnesses. Improving health literacy through education, strengthening family support systems, expanding CBHI participation for better healthcare access, and developing targeted chronic disease management programs to enhance this behavior is recommended. These strategies can collectively improve healthcare utilization and outcomes for older people.

Rural-urban disparity in community-based health insurance enrollment in Ethiopia: a multivariate decomposition analysis using Ethiopian Mini Demographic Health Survey 2019.

In sub-Saharan Africa, achieving universal health coverage (UHC) and protecting populations from health-related financial hardship remain challenging goals. Subsequently, community-based health insurance (CBHI) has gained interest in low and middle-income countries, such as Ethiopia. However, the rural-urban disparity in CBHI enrollment has not been properly investigated using multivariate decomposition analysis. Therefore, this study aimed to assess the rural-urban disparity of CBHI enrollment in Ethiopia using the Ethiopian Mini Demographic Health Survey 2019 (EMDHS 2019). This study used the latest EMDHS 2019 dataset. STATA version 17.0 software was used for analyses. The chi-square test was used to assess the association between CBHI enrollment and the explanatory variables. The rural-urban disparity of CBHI enrollment was assessed using the logit-based multivariate decomposition analysis. A p-value of <0.05 with a 95% confidence interval was used to determine the statistical significance. The study found that there was a significant disparity in CBHI enrollment between urban and rural households (p < 0.001). Approximately 36.98% of CBHI enrollment disparities were attributed to the compositional (endowment) differences of household characteristics between urban and rural households, and 63.02% of the disparities were due to the effect of these characteristics (coefficients). The study identified that the age and education of the household head, family size, number of under-five children, administrative regions, and wealth status were significant contributing factors for the disparities due to compositional differences between urban and rural households. The region was the significant factor that contributed to the rural-urban disparity of CBHI enrollment due to the effect of household characteristics. There were significant urban-rural disparities in CBHI enrollment in Ethiopia. Factors such as age and education of the household head, family size, number of under-five children, region of the household, and wealth status of the household contributed to the disparities attributed to the endowment, and region of the household was the contributing factor for the disparities due to the effect of household characteristics. Therefore, the concerned body should design strategies to enhance equitable CBHI enrollment in urban and rural households.

Insured-non-insured disparity of catastrophic health expenditure in Northwest Ethiopia: a multivariate decomposition analysis

BackgroundFinancial risk protection is one indicator of universal health coverage (UHC). All people should be protected from financial risks such as catastrophic health expenditures (CHE) to ensure equitable health services. Ethiopia has launched community-based health insurance (CBHI) since 2011 to protect people from financial risk. However, out-of-pocket health expenditure is a financial barriers to achieve UHC. The insured-non-insured disparity of CHE has not been well studied in Ethiopia in general and in Debre Tabor town in particular. Therefore, this study aimed to assess the disparity of CHE between insured and non-insured households and its contributing factors in Debre Tabor town.MethodsThis study used the primary household survey data collected from May to June 2022 in Debre Tabor town. Data were collected from 825 household heads and analyzed using STATA version 17.0 statistical software. Logit-based multivariate decomposition analysis was conducted to determine insured-non-insured disparity of CHE. Statistical significance for all analysis was declared at a p < 0.05.ResultsThe incidence of CHE was 17.94% and 5.58% among non-insured and insured households, respectively. About 53% and 153.20% of the insured-non-insured disparities in the magnitude of CHE were due to the difference in characteristics (endowments) and the effect of characteristics (coefficients), respectively. Age of the household head between 46 and 60 years and above 60 years, divorced and widowed marital status of household head, and chronic health conditions were the explanatory variables widening the gap in the incidence of CHE. However, do not seeking traditional medicine, family size above 4, and age of household head between 31 and 45 years were the variables contribute in reducing the gap (i.e. due to endowments) in the incidence of CHE between insured and non-insured households. Moreover, the variables that contributed to the gap in the incidence of CHE due to covariate effects were age (31–45) and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines.ConclusionThis study revealed there is a significant disparity in the incidence of CHE between insured and non-insured households. Age, marital status and occupation of the household head, family size of household, presence of a chronically ill household member and seeking traditional medicine were significantly contributing factors for the disparity of CHE between insured and non-insured households due to endowments. The variables that contributed to the disparity in the incidence of CHE due to covariate effects were age and marital status of household head, wealth status, family size, ownership of the household, and seeking traditional medicines. Therefore, the policy makers need to emphasize in increasing the insurance coverage among households, and providing affordable health services in Ethiopia in general and Debre Tabor town in particular.

Patient satisfaction with pharmacy services among users and non users of community based health insurance scheme at public health facilities in Gamo Zone, South Ethiopia: a comparative cross sectional study

BackgroundPatient satisfaction is a crucial humanistic outcome metric in pharmacy services. There was a lack of evidence on patients’ satisfaction with pharmacy services in Gamo zone among users and nonusers of the CBHI scheme. Therefore, the aim this study is to compare the level of patient satisfaction with pharmacy services among users and nonusers of community based health insurance scheme at public health facilities in Gamo zone, South Ethiopia.MethodA facility based comparative cross sectional study design with mixed approach was conducted from June 1 to 30, 2023. A total of 522 study participants and 16 key informants were included as the sample size for quantitative and qualitative study, respectively. The quantitative data was gathered from the study participants who visited the outpatient pharmacy department during the study period by using a simple random sampling technique, while the purposive sampling technique was used to select clients and key informants for the qualitative study. The adjusted odds ratio (AOR) was used to measure the association between independent variables and patient satisfaction toward outpatient pharmacy services at the P values < 0.05 and 95% confidence interval (CI).ResultsFrom the total of study participants, 195 (73.9%) of insured and 175 (67.8%) of noninsured clients were satisfied with pharmacy services offered at public health facilities. The gender of insured (95% CI = 2.00-12.36, (p 0.01)), and noninsured (95% CI = 0.658–2.881, (p 0.02)), waiting time of insured (95% CI = 0.057–0.766, (p 0.0027)), and noninsured (95% CI = 0.084–0.925, (p 0. 0021)) and premium affordability of insured (95% CI = 0.0605-4.860, (p 0.00)) were significantly associated factors with client satisfaction at p < 0.05 and 95% CI. Based on qualitative finding, as member of the CBHI scheme, the members had a greater opportunity to receive a good pharmacy services, because they were more familiar with the physicians and the institutions.ConclusionThe clients with insurance perceived high level of satisfaction with pharmacy services in public health facilities than noninsured. The gender and waiting times at outpatient pharmacy department for both groups of study participants and the premium affordability for the insured groups of clients were factors affecting client satisfactions with pharmacy services.

Does community-based health insurance affect lifestyle and timing of treatment seeking behavior? Evidence from Ethiopia

ObjectivesThis paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance (CBHI) scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms. There is growing concern about the financial sustainability of CBHI schemes in developing countries. However, few empirical studies have identified potential contributors, including ex-ante and ex-post moral hazards. MethodsWe implement a household fixed-effect panel data regression model, drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia. ResultsThe findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals. However, CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms. Particularly, on average, we estimate about 4‒6 h delay for malaria symptoms, a little above 4 h for tetanus, and 10‒11 h for tuberculosis among the insured households. ConclusionsWhile there is evidence that CBHI improve the utilization of outpatient or primary care services, our study suggests that insured members may wait longer before visiting health facilities. This delay could be partly due to moral hazard problems, as insured households, particularly those from rural areas, may consider the opportunity costs associated with visiting health facilities for minor symptoms. Overall, it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

Willingness to join community-based health insurance and its associated factors among households in Nekemte City, Ethiopia. A community-based cross-sectional study

IntroductionEthiopia has been implementing community-based health insurance programs since 2011 to improve health care financing system. However, the prevalence of household willingness to join the community-based health insurance (CBHI) program and its associated factors are less explored in urban area. Therefore, this study was aimed to assess the prevalence of willingness to join community-based health insurance program and its associated factors among households in Nekemte City, Ethiopia.MethodsA community-based cross-sectional study was conducted on 422 randomly selected households in Nekemte City, Ethiopia. Bivariate and multivariable analyses were performed to see the association between the independent and outcome variables using binary logistic regression model. Association was described using an adjusted odd ratio (AOR) and a 95% confidence interval (CI). Finally, p-value < 0.05 was considered the cut-off point for declaring a significant.ResultsAmong 422 study participants, 320 (75.83%) [95% CI = 71.5-79.8%)] of the households were willing to join community-based health insurance program. The willingness to join for community-based health insurance was 3.11 times more likely among households who were in the richest quintile (AOR = 3.11; 95% CI = 1.08–8.93), 3.4 times more likely among those who were merchants (AOR = 3.40;1.33, 8.69), 2.52 times more likely among those who had history of chronic illness in the household (AOR = 2.52; 95% CI = 1.43–4.45), 4.09 times more likely among those who had the awareness about the scheme (AOR = 4.09; 95% CI = 1.97–8.47) and 3.29 times more likely among those who had the experience of borrow for medical care (AOR = 3.29; 95% CI = 1.48–7.30).ConclusionNearly three fourth of the households were willing to join community-based health insurance program, however, about one fourth of households were not willing, which is a significant public health problem. Being merchant, having awareness about the scheme, being in the richest wealth quintile, having experience of borrowing for medical care, and having history of chronic illness in the household were factors found to be significantly associated with willingness to join community based health insurance in the study area. Therefore, strengthening awareness creation at community level about the benefit package and principle of the program would increase their demand for the community-based health insurance scheme.

Spatial distribution and geographical heterogeneity factors associated with households' enrollment level in community-based health insurance.

Healthcare service utilization is unequal among different subpopulations in low-income countries. For healthcare access and utilization of healthcare services with partial or full support, households are recommended to be enrolled in a community-based health insurance system (CBHIS). However, many households in low-income countries incur catastrophic health expenditure. This study aimed to assess the spatial distribution and factors associated with households' enrollment level in CBHIS in Ethiopia. A cross-sectional study design with two-stage sampling techniques was used. The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. STATA 15 software and Microsoft Office Excel were used for data management. ArcMap 10.7 and SaTScan 9.5 software were used for geographically weighted regression analysis and mapping the results. A multilevel fixed-effect regression was used to assess the association of variables. A variable with a p < 0.05 was considered significant with a 95% confidence interval. Nearly three out of 10 (28.6%) households were enrolled in a CBHIS. The spatial distribution of households' enrollment in the health insurance system was not random, and households in the Amhara and Tigray regions had good enrollment in community-based health insurance. A total of 126 significant clusters were detected, and households in the primary clusters were more likely to be enrolled in CBHIS. Primary education (AOR: 1.21, 95% CI: 1.05, 1.31), age of the head of the household >35 years (AOR: 2.47, 95% CI: 2.04, 3.02), poor wealth status (AOR: 0.31, 95% CI: 0.21, 1.31), media exposure (AOR: 1.35, 95% CI: 1.02, 2.27), and residing in Afar (AOR: 0.01, 95% CI: 0.003, 0.03), Gambela (AOR: 0.03, 95% CI: 0.01, 0.08), Harari (AOR: 0.06, 95% CI: 0.02, 0.18), and Dire Dawa (AOR: 0.02, 95% CI: 0.01, 0.06) regions were significant factors for households' enrollment in CBHIS. The secondary education status of household heads, poor wealth status, and media exposure had stationary significant positive and negative effects on the enrollment of households in CBHIS across the geographical areas of the country. The majority of households did not enroll in the CBHIS. Effective CBHIS frameworks and packages are required to improve the households' enrollment level. Financial support and subsidizing the premiums are also critical to enhancing households' enrollment in CBHIS.

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 &lt; 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

Awareness and Utilization of Community-based health insurance schemes among residents of Rumuokwurusi, Obio/Akpor LGA, Rivers State

Community-based health insurance (CBHI) in a developing country such as ours aims at achieving universal health coverage, especially for those not financially capable of footing out-of-pocket medical bills. CBHI schemes can help communities manage healthcare costs and provide access to basic healthcare for rural settlers. This study aimed at assessing the awareness and utilisation of CBHI schemes in Obio/Akpor Local Government Area (LGA), Rivers State, Nigeria.This was a descriptive cross-sectional study, employing the multistage probability sampling technique to select participants for the study. Semi-structured interview-er-administered questionnaires were de-signed for obtaining information from 250 respondents on the title. Data were analyzed on Excel spreadsheets, having been extrapolated from Google Forms, and results presented in frequency tables. The p-value was set at &lt;0.05 where Chi-square was necessary.Of the 250 respondents, 114 (45.6%) were aware of community-based health insurance, but only 86 (34.4%) were acquainted with the existence of Community-based health insurance schemes in Obio/Akpor LGA. Only 26 (10.4%) utilized Community-based Health Insurance Schemes.Awareness and utilization of CBHI schemes in our study area are very low. Recommended strategies need to be addressed urgently to improve equity in access to health care services as well as effective financial risk protection.

Determinants for Rural Households Willingness to Pay for Community Based Health Insurance: The case of Boloso Sore District in Woliata Zone, South Ethiopia, Ethiopia

Transforming health system of rural households through Community Based Health Insurance package is one of the interventions by the government of Ethiopia to address rural community. However, majority of rural households not enrolled in community based health insurance program in Boloso Sore district. This study, thus designed to assess the existing situation of households WTP and to assess factors determining WTP for CBHI in Boloso Sore district. Both quantitative and qualitative data were collected from sampled households for analysis. The data were collected from both primary and secondary data sources. To do so, semi-structured household interview questions and check lists were developed and conducted with sampled respondents. Descriptive statistics employed following econometric analysis of the data collected from 386 households selected using simple random sampling from nine Kebeles of Boloso Sore district. Binary logit regression analysis showed that age, education level, employment status, saving practice, land size, distance to health facility and access to health education have positive and significant association with WTP for CBHIs. Therefore, the findings indicated that health education, saving practices and road facility need to be promoted by the government to improve CBHIs of the rural community.

Comparing healthcare service utilization in insured vs. noninsured households in Rural Atsbi Womberta, Ethiopia

Community-based health insurance schemes (CBHI) in Africa are gaining attention due to high healthcare costs in developing nations, affecting 6% of individuals in extreme poverty. The World Health Organization emphasizes the need for sustainable health funding schemes to ensure access to health services. Ethiopia faces poor healthcare funding, making it one of the world's poorest nations. Tigray implemented community-based insurance as a pilot study in 69 rural communities since 2010. The objective of this study was compare differences in healthcare service utilization between community-based health insurance among insured and non-insured households in rural Atsbi-Wemberta district. A community-based comparative cross-sectional study with a qualitative approach was conducted on 172 households. Data was analyzed using SPSS, and inferential statistics were used to measure factors' association with outcome variables. A study in Kebelle revealed that the majority of respondents were female-headed, engaged in both insurance schemes, and had higher education levels. Marital status was also significant, with 89% living with their families. The majority were married, with 91.8% insured and 86.0% uninsured. Family size and income were significant factors, with high-salary households less likely to be members of the CBHI scheme. The study found that most participants considered themselves intermediate healthcare providers, with limited service due to affordability and segregation. The study suggests increasing healthcare service utilization by introducing CBHI to improve access to healthcare and promote good governance. However, the study faces criticism for unfairness and insufficient benefits for non-insured participants. Household were enrolled in CBHI (56.2%) were more probable to use health care service than households who were not enrolled (43.8%) (χ2=21.359, p&lt;0.001). Community Benefits Insurance (CBHI) has increased healthcare utilization among insured households due to reduced illness costs and increased healthcare professional involvement. Factors like income, family size, and travel time contribute to higher utilization. However, challenges include lack of knowledge and community awareness.

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.