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Determinants of enrollment in community based health insurance among Households in Tach-Armachiho Woreda, North Gondar, Ethiopia, 2019.

ABSTRACT: BACKGROUND:Recently in Ethiopia, there is an increasing movement to implement community based health insurance scheme as integral part of health care financing and remarkable movements has resulted in the spread of the scheme in different parts of the country. Despite such increasing effort, recent empirical evidence shows enrolment has remained low. To identify determinants of enrollment in community based health insurance among households in Tach-Armachiho Woreda, North Gondar, Ethiopia, 2019. METHODS:A community based unmatched case control study was conducted Tach-Armachiho Woreda from March to May 2019 among 262 participants (88 cases and 174 controls with case control ratio of 1:2). Study subjects were selected using multi-stage sampling technique. Data were collected using a pretested, structured interviewer administered questioner. Data were entered to Epi-info 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression model were used to see the determinants of enrollment in community based health insurance. Adjusted odds ratio with 95% CI at p-value <0.05 in multivariable logistics regression analysis factors were identified as statistically significantly associated. RESULT:Female headed households (AOR = 2.79, 95% CI = 1.16, 6.69), Increase in Age (AOR = 1.09, 95% CI = 1.05, 1.13) and negative perception towards community based health insurance (AOR = 0.062, 95% CI = .030, .128) were found to be significant predictors. CONCLUSION:This study provides evidence that the decision to enroll in the scheme is shaped by age and a combination of household head sex and perception towards community based health insurance. Implementers aimed at enhancing enrolment ought to act on the bases of this findings.

SUBMITTER: Chanie MG

PROVIDER: S-EPMC7458327 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Determinants of enrollment in community based health insurance among Households in Tach-Armachiho Woreda, North Gondar, Ethiopia, 2019.

Chanie Muluken Genetu MG Ewunetie Gojjam Eshetie GE

PloS one 20200831 8

<h4>Background</h4>Recently in Ethiopia, there is an increasing movement to implement community based health insurance scheme as integral part of health care financing and remarkable movements has resulted in the spread of the scheme in different parts of the country. Despite such increasing effort, recent empirical evidence shows enrolment has remained low. To identify determinants of enrollment in community based health insurance among households in Tach-Armachiho Woreda, North Gondar, Ethiopi ...[more]

PMID: 32866152

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Project description:BackgroundArmed conflict and natural disasters cause serious psychosocial problems. Providing comprehensive bio-psychosocial support to the community after a war, traumatic, or devastating event has a significant impact on community reconstruction and resilience. As a result, the goal of this project was to conduct community diagnosis, identify individuals experiencing psychological distress, and provide comprehensive mental health and psychosocial support for the Chenna Kebele population in Dabat Woreda, North Gondar, Ethiopia.MethodsA mixed research approach, specifically an explanatory study design, was used to assess psychosocial issues among war survivors. In-depth interviews, focus group discussions, and observation were used to assess the psychosocial and economic consequences of the war on survivors. Additionally, a structured questionnaire was employed to assess mental health problems among the target population. The project was conducted in three phases.ResultA total of 550 households were assessed using a structured questionnaire. Of them, 45 people reported a range of mental health issues, including post-traumatic stress disorder (PTSD), major depressive disorder (MDD), adjustment disorder, protracted bereavement disorder, and insomnia. PTSD is the most common diagnosis, accounting for 38 cases. Four cases of major depressive disorder, three cases of prolonged grief, and two neurologic cases were also identified during the screening. Females had a higher number of PTSD cases as compared with males. Fifteen women reported sexual violence, and the number may be high because of underreporting and refusal to disclose the situation. The result also indicated significant property damage, loss of life stocks, and disengagement from basic services like water. Intervention with follow-up was provided at the individual, group, and community levels in order to reverse the devastating situation. The intervention included pharmacotherapy, psychotherapy, and social networking.Conclusion and recommendationOverall, the community has experienced multiple psychosocial and economic problems. Hence, providing holistic mental health psychosocial support, clearing the site and burying the dead body, and re-initiating the terminated social gathering event will alleviate the existing problem and create a resilient community.

Project description:BackgroundCommunity-based health insurance programs are being acknowledged as effective strategies to attain universal health coverage and mitigate the financial catastrophic shock of the community. Even though Ethiopia has been focusing on the implementation and expansion of a community-based health insurance (CBHI) program since 2011, only a small number of people are enrolled, which might be attributed to a lack of willingness towards the program. The purpose of this study is to determine the willingness to pay for community-based health insurance and associated factors among households in the rural community of Gombora District, Hadiya Zone, southern Ethiopia.MethodsUsing the multistage systematic random sampling technique, a sample of 421 households was chosen for a community-based cross-sectional study. The desired information was gathered using a pre-tested, structured, interviewer-administered questionnaire. The data was entered using Epi-Data V3.1 and exported to SPSS version 24.0 for statistical analysis. Bivariable and multivariable logistic regression analyses were performed to determine the variables associated with the willingness to pay for community-based health insurance.ResultsThe study showed that 67.1% of respondents expressed a willingness to pay for community-based health insurance. The mean amount of money they are willing to pay for the scheme is 178.41 (± 57.21) Ethiopian Birr (ETB), or 6.43 (± 2.06) USD per household per annum in 2020. Based on multiple logistic regression analysis, belonging to Rich household compared to poor (AOR: 2.78, 95% CI: 1.54, 5.03), having a household head who can read and write (AOR: 2.90, 95% CI: 1.39, 6.05), family size greater than five (AOR: 1.76, 95% CI: 1.06, 2.92), indigenous community insurance (iddir) participation (AOR: 2.83, 95% CI: 1.61, 4.96), and the presence of chronic illness (AOR: 1.94, 95% CI: 1.21, 3.12), were significantly associated with the willingness to pay for a CBHI scheme.ConclusionHouseholds' willingness to pay for a CBHI scheme was found to be significantly influenced by poor household wealth status, household heads who cannot read and write, households with less than or equal to five family members, households who participate in greater or equal to two indigenous community insurance participations, and the absence of chronic illness within the household. Therefore, factors affecting households' willingness to pay should be considered and massive community mobilization needs to be done to strengthen and increase household membership during the implementation of the CBHI scheme, especially in rural areas.

Project description:BackgroundDespite 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.MethodsWe 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.ResultsOut 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 recommendationThe 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.

Project description:BACKGROUND:In absence of any form of health insurance, out-of-pocket payments for health care lead to decreased use of health services and catastrophic health expenditures. Community-based health insurances has been promised financial model for informal sectors to reduce these problems in many countries. When this comes down to Ethiopia, in the South Nation Nationality People's Region of the country established 52 schemes including Boricha district, the study area However, there has been little evidence about the enrollment status and the associated factors in the study area in particular elsewhere in general. OBJECTIVE:The study aims to assess the current enrollment status of households in community based health insurance and the associated factors in Boricha district of Sidama Zone, Southern Ethiopia. METHODS AND MATERIALS:A community based cross-sectional study design was employed from February 01, 2019 to March 31, 2019, using a sample of 632 households. Data were collected using interviewer-administered pre-tested questionnaire and entered into EPI-Info 7and transported to SPSSversion20 for analysis. Multi-variable logistic regression analysis along with odds ratio and the corresponding 95% CI was conducted and significance was declared at P-value <0.05. RESULTS:Current enrollment status of households in community based health insurance was found to be 81 (12.8%). According to this study, educational status; secondary school& above[AOR = 2.749, 95%CI(1.142, 6.618)], timing of collecting premium [AOR = 0.433; 95% CI (0.196, 0.958)], family size ?5, [AOR = 4.16;95%CI (1.337, 12.944)], no trust on scheme management[AOR = 0.272; 95%CI (0.140, 0.528)], lack of information [AOR = 0.086; 95%CI (0.026, 0.288)], dissatisfaction with health care service received[AOR = 0.303; 95%CI (0.171, 0.537)], no chronic illness in the family[AOR = 0.259; 95%C.I.(0.137, 0.488)] were factors significantly associated with current enrollment status in CBHI. CONCLUSIONS:Households head's education status, timing of premium collection, family size, no trust on scheme management, lack of information, services dissatisfaction and chronic illness in the family member were the identified factors associated with enrollment in CBHI in the study area. Therefore, to enhance the enrollment and sustainability of CBHI in the study area awareness creation, improving timing of premium collection, strengthening scheme management, improving quality of service are the areas that decision makers needs to intervene.

Project description:The trust that potentially community-based health insurance (CBHI) members have in the actual health insurance scheme is a crucial determinant for members who decided to enroll and continue being members of the scheme. While the literature on health insurance in low-income countries mentions the importance of trust in consumers’ decision to insure, to date the association between trust and trust-building factors has not been researched in the Ethiopian context. Therefore, the objective of this study was to assess the factors affecting households’ trust in the CBHI scheme in Ethiopia. A community-based cross-sectional study design was employed to collect data from 617 household heads from March 1–30, 2020. A multistage sampling technique was carried out and interviewer-administered questionnaires were used to collect data. Descriptive statistics and multivariable linear regression analyses were performed, and variables with a P-value < 0.05 were considered to have a statistically significant association with trust in the CBHI scheme. A household survey resulted in 617 households being interviewed making a response rate of 97.3%. The mean age of the respondents was 44.7 (SD°11.2) years and the majority of the respondents were Oromo 528(85.6%). Holding other covariant fixed, educational level of household head (ß = 0.17, 95% CI:0.14–0.32), members’ satisfaction with past experience (ß = 0.40, 95%CI:0.41–0.57), favorable attitude toward CBHI (ß = 0.31, 95%CI:0.12–0.49), perceived quality of service (ß = 0.15, 95% CI:0.02–0.29) and dropout from CBHI (ß = -0.23, 95%CI:- 0.41–- 0.05) were covariant that had an association with trust in the CBHI scheme. This study found that the educational level of the household head, members’ satisfaction with past experience, members’ attitude toward CBHI, perceived quality of services and dropout from CBHI were covariant that were affecting trust in the CBHI scheme. Therefore, if the scheme wants to build trust and maintain membership, great attention should be given toward the improvement of the quality of service and attitude of members towards the CBHI scheme. These findings suggest that CBHI managers, different health insurance agencies, providers and policymakers need to think systematically about a wide range of initiatives that enhance trust and caring, and to design trust-building structures and practices that sustain the CBHI scheme.

Project description:ObjectivesThe utilization of long-acting reversible contraceptive methods is one of the key factors in protecting women and couples against unwanted pregnancies. The study aimed to assess the determinants of long-acting reversible contraceptive use among women in Northwest Ethiopia.MethodsA community-based unmatched case-control study was conducted from 1 February to 8 March 2017 in Northwest Ethiopia. The cases were women who used long-acting reversible contraceptive methods, and the controls were women who used short-acting contraceptives. Both of them were selected using a systematic sampling method. An interviewer-administered questionnaire was used to collect the data. Epi info and SPSS version 23 were used for data entry and analysis, respectively. Descriptive statistics and association measures were done and presented in texts, tables, and figures.ResultsA total of 882 women were interviewed, with a response rate of 99.3%. Women who were between 15 and 24 years old were two times more likely to use long-acting reversible contraceptive methods than those whose age was ⩾35 (adjusted odds ratio = 2, 95% confidence interval: (1.20, 3.50)). A good level of knowledge about long-acting reversible contraceptive methods (adjusted odds ratio = 11.6, 95% confidence interval: (5.42, 24.80)), a negative attitude toward long-acting reversible contraceptive methods (adjusted odds ratio = 0.31, 95% confidence interval: (0.21, 0.46)), membership in the health development army (adjusted odds ratio = 2.8, 95% confidence interval: (2.12, 3.78)), no discussion with a partner about long-acting reversible contraceptive methods (adjusted odds ratio = 2.3, 95% confidence interval: (1.54, 3.49)), and more than 2 years of desire to wait before another pregnancy (adjusted odds ratio = 23.7, 95% confidence interval: (11.63, 48.55)) were determinants of long-acting reversible contraceptive methods use.ConclusionThis study revealed that attitude toward long-acting reversible contraceptive method use, being a member of the women's health development army, and the desire to space children were determinants of long-acting reversible contraceptive method use. More actions should be taken to increase the utilization of long-acting reversible contraceptive methods by promoting discussion between partners about modern contraceptives and increasing women's participation in being a member of the health development army.

Project description:Background Community-based health insurance (CBHI) is a risk-pooling approach that tries to disperse health expenditures across families with varying health profiles to provide greater access to healthcare services by allowing cross-subsidies from wealthy to poor populations. It is crucial to assess the level of CBHI enrolment and its determinants in Ethiopia, where government health spending is limited to less than 5% of GDP, far below the Alma Ata Declaration’s benchmark of 15%. Although various epidemiological studies on CBHI enrolment status and its determinants have been undertaken in Ethiopia, the results have been inconsistent, with significant variability. However, no nationwide study assessing the pooled estimates exists today. Furthermore, the estimated strength of association at the country level varied and was inconsistent across studies. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of CBHI enrolment and its determinants in Ethiopia. Methods A comprehensive search of studies was done by using PubMed, EMBASE, Science Direct, HINARI, Scopus, Web of Science, and the Cochrane Library. The database search was complemented by google scholar and some repositories for grey literature. The search was carried out from February 11 to March 12, 2022. The relevant data were extracted using a Microsoft Excel 2013 spreadsheet and analyzed using STATATM Version 16. Studies reporting the level and determinants of CBHI enrolment in Ethiopia were considered. A weighted DerSimonian Laired random effect model was applied to estimate the pooled national prevalence of CBHI enrolment. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the included studies. A funnel plot, Begg’s and Egger’s tests, were used to check for the presence of publication bias. Results Fifteen studies were eligible for this systematic review and meta-analysis with a total of 8418 study participants. The overall pooled prevalence of CBHI enrolment in Ethiopia was 45.5% (95% CI: 32.19, 58.50). Affordability of premium for the scheme[OR = 2.58, 95% CI 1.68, 3.47], knowledge of respondents on the CBHI scheme[OR = 4.35, 95% CI 2.69, 6.01], perceived quality of service[OR = 3.21, 95% CI 2.04, 4.38], trust in the scheme[OR = 2.32, 95% CI 1.57, 3.07], and the presence of a person with a chronic disease in the household [OR = 3.58, 95% CI 2.37, 4.78] were all found to influence CBHI enrolment. Conclusion Community health workers (CHWs) need to make a high effort to improve knowledge of CBHI in rural communities by providing health education. To deal with the issue of affordability, due emphasis should be placed on building local solidarity groups and strengthening local initiatives to aid poor members. Stakeholders in the health service delivery points need to focus on the dimensions of high service quality. The financial gap created by the adverse selection of households with chronically ill members should be rectified by implementing targeted subsidies with robust plans.

Dataset Information

Determinants of enrollment in community based health insurance among Households in Tach-Armachiho Woreda, North Gondar, Ethiopia, 2019.

Publications

Determinants of enrollment in community based health insurance among Households in Tach-Armachiho Woreda, North Gondar, Ethiopia, 2019.

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