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Factors affecting enrollment status of households for community based health insurance in a resource-limited peripheral area in Southern Ethiopia. Mixed method

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Listed:
  • Mustefa Glagn Abdilwohab
  • Zeleke Hailemariam Abebo
  • Wanzahun Godana
  • Dessalegn Ajema
  • Manaye Yihune
  • Hadiya Hassen

Abstract

Background: Despite the efforts made by the government of Ethiopia, the community-based health insurance (CBHI) enrollment rate failed to reach the potential beneficiaries. Therefore, this study aimed to assess the enrollment status of households for community-based health insurance and associated factors in peripheral areas of Southern Ethiopia. Methods: We conducted a community based cross-sectional study design with both quantitative and qualitative methods. Systematic random sampling was employed to select 820 households from 27, April to 12 June 2018. A pretested structured questionnaire, in-depth interview, and focus group discussion guiding tool were used to obtain information. A binary logistic regression model was used to assess the association between independent and outcome variables. A P-Value of less than 0.05 was taken as a cutoff to declare association in multivariable analysis. Qualitative data were analyzed manually using the thematic analysis method. Results: Out of 820 households, 273[33.30%; 95% CI: 29.9–36.20] were enrolled in the community based health insurance scheme. Having good knowledge [AOR = 13.97, 95%CI: 8.64, 22.60], having family size of greater than five [AOR = 1.88, 95% CI: 1.15, 3.06], presence of frequently ill individual [AOR = 3.90, 95% CI: 2.03, 7.51] and presence of chronic illness [AOR = 3.64, 95% CI: 1.67, 7.79] were positively associated with CBHI enrollment. In addition, poor quality of care, lack of managerial commitment, lack of trust and transparency, unavailability of basic logistics and supplies were also barriers for CBHI enrollment. Conclusion and recommendation: The study found that lower community based health insurance enrollment status. A higher probability of CBHI enrollment among higher health care demanding population groups was observed. Poor perceived quality of health care, poor managerial support and lack of trust were found to be barriers for non-enrollment. Therefore, wide-range awareness creation strategies should be used to address adverse selection and poor knowledge. In addition, trust should be built among communities through transparent management. Furthermore, the quality of care being given in public health facilities should be improved to encourage the community to be enrolled in CBHI.

Suggested Citation

  • Mustefa Glagn Abdilwohab & Zeleke Hailemariam Abebo & Wanzahun Godana & Dessalegn Ajema & Manaye Yihune & Hadiya Hassen, 2021. "Factors affecting enrollment status of households for community based health insurance in a resource-limited peripheral area in Southern Ethiopia. Mixed method," PLOS ONE, Public Library of Science, vol. 16(1), pages 1-16, January.
    • Handle: RePEc:plo:pone00:0245952
    DOI: 10.1371/journal.pone.0245952
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    References listed on IDEAS

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    1. Pablo Gottret & George Schieber, 2006. "Health Financing Revisited : A Practitioner's Guide," World Bank Publications - Books, The World Bank Group, number 7094, April.
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    1. Hsiao, William C. & Yip, Winnie, 2024. "Financing and provision of healthcare for two billion people in low-income nations: Is the cooperative healthcare model a solution?," Social Science & Medicine, Elsevier, vol. 345(C).
    2. Yikeber Abebaw Moyehodie & Solomon Sisay Mulugeta & Seyifemickael Amare Yilema, 2022. "The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia," PLOS ONE, Public Library of Science, vol. 17(10), pages 1-14, October.
    3. Goodluck Mselle & Peter Nsanya & Kennedy Diema Konlan & Yuri Lee & Jongsoo Ryu & Sunjoo Kang, 2022. "Factors Associated with the Implementation of an Improved Community Health Fund in the Ubungo Municipality Area, Dar es Salaam Region, Tanzania," IJERPH, MDPI, vol. 19(9), pages 1-12, May.
    4. Aklilu Habte & Aiggan Tamene & Tekle Ejajo & Samuel Dessu & Fitsum Endale & Addisalem Gizachew & Dawit Sulamo, 2022. "Towards universal health coverage: The level and determinants of enrollment in the Community-Based Health Insurance (CBHI) scheme in Ethiopia: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 17(8), pages 1-21, August.
    5. Tamisai Chipunza & Senia Nhamo, 2023. "Potential demand for National Health Insurance in Zimbabwe: Evidence from selected urban informal sector clusters in Harare," PLOS ONE, Public Library of Science, vol. 18(5), pages 1-28, May.

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