Willingness to join community based health insurance among households in South Wollo, Northeast Ethiopia: A community-based cross-sectional study

Willingness to join community-based health insurance and associated factors among households in Ethiopian: a systematic review and meta-analysis

BACKGROUND

In Ethiopia, out-of-pocket medical expenses make up one-third of all medical expenses, which makes it difficult for households to obtain and utilize healthcare. One of the prepayment mechanisms that shield low-income households from unaffordable medical bills is the community-based health insurance (CBHI) program. This systematic review and meta-analysis aimed to estimate the pooled willingness to join Community-based Health Insurance schemes and its associated factors among households in Ethiopia.

METHODS

Articles were searched from PubMed, Google Scholar, Web of Science, Scopus, Science Direct, and Ethiopian Universities' repositories for grey literature. The study used the modified PRISMA guidelines for rewriting and reviewing the literature. The quality of studies was assessed using Joanna Briggs Institute Critical Appraisal tools. Data was extracted using Microsoft Excel and exported to STATA version 16 software for analysis. Cochran's Q statistic and I2 tests were utilized to determine the heterogeneity between studies. Studies publication bias was determined using a funnel plot and Egger's test. Subgroup analysis was conducted to demonstrate variations of the effect sizes across study regions. Finally, we utilized a random-effect model to compute the overall willingness to join the CBHI scheme and its determinants among households in Ethiopia.

RESULT

We included thirty studies to determine the pooled prevalence of willingness to join the CBHI scheme and its determinants. The pooled magnitude of households' willingness to join the CBHI scheme was 60.42% (95% CI: 51.45%, 69.38%). Old aged (AOR = 2.17, [95% CI: 1.37, 3.44], I2 = 82.33%), formal educational status(AOR = 2.74, [95% CI: 2.10, 3.56], I2 = 59.85%), Rich wealth index (AOR = 2.51, [95% CI: 1.99, 3.18], I2 = 48.25%), good knowledge/awareness of CBHI scheme(AOR = 4.21, [95% CI: 3.01, 5.88], I2 = 66.0%), experienced illness in the last three months (AOR = 3.42, [95% CI: 2.19, 5.35], I2 = 71.15%), and large family size (AOR = 2.36, [95% CI: 1.95, 2.87], I2 = 50.81%) were determinants of willingness to join the CBHI scheme. In addition, affordability of CBHI premium (AOR = 3.12, [95% CI: 2.34, 4.14], I2 = 10.35%), poor health status (AOR = 3.23, [95% CI: 2.57, 4.06], I2 = 35.97%), trust in scheme (AOR = 4.38, [95% CI: 1.91, 10.06], I2 = 88.35%), chronic diseases (AOR = 3.24, [95% CI: 2.40, 4.37], I2 = 67.15%) and good quality of healthcare services (AOR = 2.91, [95%CI:2.08, 4.09], I2 = 65.40%) were also predictors of willingness to join the CBHI program.

CONCLUSION

The pooled prevalence of willingness to join the CBHI scheme was low and below the national target of 80%. Age, family size, educational status, wealth status, illnesses in last three months, presence of chronic illnesses, affordability of the premium for the CBHI scheme, self-reported health status, Knowledge/awareness of the scheme, trust in the scheme and perceived quality of healthcare service were significantly determine the willingness to join the CBHI scheme. Health providers should provide detailed awareness creation through health education on the concepts and principles of the CBHI scheme.

Households willingness to join and pay for community-based health insurance: implications for designing community-based health insurance based on economic Status in Ethiopia

BACKGROUND

Despite the encouraging results achieved by community-based health insurance in Ethiopia, the program faces significant challenges. Among these challenges is the current practice where premium contributions to Community Based Health Insurance are either a flat rate or based solely on family size, rather than considering households' socio-economic status The overall aim of this study was to assess households' willingness to join and pay for Community Based Health Insurance in reference to socio-economic status to design sliding scale-based Community Based Health Insurance contributions in Ethiopia.

METHODS

A community based cross-sectional study was conducted in districts from two different contexts: urban areas and agrarian areas in two major regions in Ethiopia, namely Oromia, and Amhara. A double-bounded dichotomous contingent valuation method was used to determine households' willingness to pay. Descriptive statistics were used to summarize the data. A chi-square test was used to assess background factors associated with willingness to join and pay for Community Based Health Insurance, and tobit regression analyses were conducted to identify factors that determine the amount of willingness to pay for Community Based Health Insurance. The statistical significance of all results was interpreted using an adjusted two-sided Type I error rate of 0.05.

RESULT

A total of 786 households participated in this study. Overall, 532 (67.7%) study households have ever participated in the Community Based Health Insurance scheme. The reason for never participating was unaffordability of payment (30.3%), and they stated that the service was unsatisfactory (21.7%). Generally, 647 (82.3%) of the households were willing to join Community Based Health Insurance or renew their scheme membership in the future, with higher willingness among rural and urban residents and households with food insecurity (p < 0.05. The average amount households were willing to pay was 538.2 Ethiopian Birr with mode (570.0 Ethiopian Birr). In contrast with the existing premium contribution policy, the vast majority of households preferred premium contributions that considered households' economic status (81.2%). Increased household size, better household food security, and being rural residents, increased satisfaction with the scheme; and rural households' economic status significantly predicted the value of money households are willing to contribute to Community Based Health Insurance (p < 0.05).

CONCLUSION

This study revealed a strong willingness among community members to participate in or renew their membership in the Community Based Health Insurance scheme, with a clear preference for a socio-economic-based sliding scale approach over current flat rate or family size-dependent premium systems. This preference highlights the potential for transforming towards more equitable citizen contributions. Policymakers should therefore consider household economic status, alongside factors like household food security and family size, in determining Community Based Health Insurance membership fees. Furthermore, enhancing the quality of healthcare services is essential to boosting Community Based Health Insurance member satisfaction and ensuring the program's long-term sustainability. This comprehensive approach not only improves health outcomes but also strengthens community trust and support for the Community Based Health Insurance initiative.

Community-Based Health Insurance Utilization and Its Determinants among Informal Workers: Cross-Sectional Study

Background

Ethiopia has implemented a community-based health insurance (CBHI) program to provide coverage to 80% of the population and shield underprivileged individuals from the detrimental effects of exorbitant medical expenses. However, there is a paucity of data regarding its utilization and pertinent concerns. This study aimed to evaluate the utilization of CBHI and its associated factors among informal workers in Berek District.

Methods

This community-based cross-sectional study was conducted between June 15 and July 15, 2022. The sample population comprised 538 households selected using a multistage sampling approach. Data analysis was done using SPSS Version 26. Variables with P-values of less than 0.25 during the bivariate analysis were selected for multivariate analysis using binary logistic regression. The statistical significance threshold was set at a p-value of 0.05.

Results

The utilization of Community-Based Health Insurance (CBHI) was 49.8%. Age between 30 and 39 years, monthly earnings of less than 1500 Ethiopian Birr, presence of chronic illness, membership in social organization, and possessing adequate knowledge were found to have a statistically significant association with the use of CBHI.

Conclusion

The utilization of CBHI was low within the confines of this district Age, income, social group membership, and chronic illnesses were significantly associated with CBHI utilization.

Differentials in the Prevalence of Acute Respiratory Infections Among Under-Five Children: An Analysis of 37 Sub-Saharan Countries

Objective

We investigated the prevalence and risk factors of ARI in children under 5 years old in 37 SSA countries.

Methods

Data from Demographic and Health Survey (DHS) of 37 African countries was examined in this analysis. Data from children under the age of 5 years old were examined. Forest plot was used to identify disparities in the occurrence of ARIs across SSA countries.

Results

We observed a higher prevalence of ARI among children under 5 in Uganda, Kenya, Sao Tome and Principe (9% each), Gabon, Chad, Eswatini (8% each), Burundi, Ethiopia, Congo Democratic Republic (7.0% each). The prevalence of ARI among under-five children who sought medical advice/treatment from health facility was higher in South Africa (88%), Sierra Leone (86%), Tanzanian (85%), Guinea (83%) and Uganda (80%). The prevalence rate of ARI among under-five children who received antibiotics was higher in Tanzania (61%), Sao Tome and Principe (60%), Rwanda and Congo (58% each), Angola (56.0%), Mozambique (54.0%), Kenya (53.0%), Namibia (52.0%) and Gabon (50.0%). This study found that the household wealth index, maternal education, and urban residence were significantly associated with ARI (p <0.001). A higher prevalence of ARI was observed among urban residents, low income families, and those with mothers with lower education.

Conclusion

ARI prevalence could be reduced by improving household socioeconomic status, child nutrition and community awareness of indoor and outdoor pollution. Interventions and programs focused on early diagnosis, treatment and prevention of ARIs are crucial in reducing ARIs particularly in developing countries.