Community health insurance in Uganda: Why does enrolment remain low? A view from beneath

Basaza, Robert; Criel, Bart; Stuyft, Patrick Van der

doi:10.1016/j.healthpol.2007.12.008

Cited by 125 publications

(193 citation statements)

References 16 publications

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“…Villagers living in places far from the health centres were less likely to join the MHI scheme compared to those who lived nearby. The significant impact of non financial barriers has resulted in varying effects of MHI schemes in different parts of developing countries [40–45]. In designing MHI schemes for rural Bangladesh, the provider thus has to acknowledge these non financial barriers and work towards narrowing the inequities resulting from them.…”

Section: Discussionmentioning

confidence: 99%

Who enrols in voluntary micro health insurance schemes in low-resource settings? Experience from a rural area in Bangladesh

Mahmood

Hanifi

Mia

et al. 2018

Global Health Action

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Background: Micro health insurance (MHI) has proved to be a potential health-financing tool for many developing countries. Bangladesh also included MHI in its current health-financing strategy which aims to achieve universal health coverage. However, low uptake, low renewal and high dropouts have historically challenged financial sustainability of these schemes. Objective: This study aims to identify factors influencing people from low-resource settings, particularly those from Bangladesh, to enrol in MHI schemes. Methods: The study analyses the ‘Amader Shasthya’ MHI scheme operating in Chakaria, a sub-district under Cox’s Bazar district, Bangladesh. A household survey was carried out during May–June 2016 among 2,000 households from the scheme coverage area. The Outreville’s insurance-demand framework was used to identify enrolment influencing factors. Multivariate logistic regression analysis was carried out to identify significant influencing factors of enrolment. Results: Enrolment influencing factors were identified in four dimensions: economic, socio-cultural, demographic and structural. Households with the main income earner having 10+ years of schooling (odds 1.9 [CI 1.2–2.9] compared to illiterate), having financial literacy (odds 1.5 [CI 1.2–1.8] compared to financially illiterate) and being a public/private service holder (odds 1.6 [CI 1.1–2.4] compared to menial labour) were more likely to enrol. Membership in development programmes of NGOs also influenced enrolment decision significantly (odds 1.3 [CI 1.0–1.5]). The presence of chronic illness in household encouraged enrolment (odds 1.5 [CI 1.2–1.8]). Households living closer to health centres were more likely to enrol (odds 2.1 [CI 1.6–2.7]) compared to those living further away. Conclusion: The findings are expected to have significant implications in terms of designing similar health insurance schemes, particularly in terms of designing demand-driven and context adapted schemes that have greater potential to attract a larger client pool, ensure effective risk pooling and eventually expedite the achievement of universal health coverage in low-resource settings.

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Section: Discussionmentioning

confidence: 99%

Who enrols in voluntary micro health insurance schemes in low-resource settings? Experience from a rural area in Bangladesh

Mahmood

Hanifi

Mia

et al. 2018

Global Health Action

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“…Several studies have documented on the influence of socio-demographic factors on membership renewal and subscription into NHIS (Basaza et al, 2008;Dong et al, 2009;Nketiah-Amponsah, 2009;Sarpong et al, 2010). in his study report that closeness to the scheme office was preferred to than when it was farther.…”

Section: Introductionmentioning

confidence: 99%

Perceptions of Care, Socio-Demographic Characteristics and Health Care Utilisation among Health Insurance users in Ghana

Appiah¹

2015

Journal of Social Sciences

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The socio-demographic characteristics of clients and their perception of quality of care play a major part in people's decision making process especially in service utilization. This study assesses the relationship between clients' socio-economic features as well as their perceived quality on health care utilization. The study adopted a nonexperimental cross sectional design in eliciting information from health clients who accessed health services in ten selected hospitals in the Kumasi Metropolis with a cluster sampling design to select 400 clients from the ten health facilities purposely selected. The researcher used interviews and semi structured questionnaires to collect data and used SPSS version 20 for processing whiles descriptive and inferential statistics was supported with STATA 11. Perception about the quality of health provision influenced access of healthcare with NHIS cards. Clients who viewed the overall quality of health provision as good or very good were more likely to access healthcare with NHIS card as compared to those who rated the overall health provision as poor or very poor (OR = 2.1; p<0.01). Socio-demographic factors continuously play a strong role in influencing clients to access health care under the National Health Insurance Scheme (NHIS) as the high income groups still dominate in utilizing health care services under the scheme than the deprived and the poor. Increased enrolment in the scheme should be supported with provision of quality services to enhance clients' satisfaction. Also, socio-demographic characteristics influence the utilization of health care.

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“…The value that farmer-clients see in a product is critical in determining both the type of instrument and its quantity. Additionally, field studies have shown that trust in both the product and the provider are crucial in determining enrolment in insurance programmes Dong et al 2009;Basaza et al 2008;Matul et al 2013) Indeed, increased understanding of the product, recognising value and trusting the insurance agent and agency are all important in determining the uptake of FARM products and services. All these outcomes (understanding the importance of insurance; perceived value; and trust) affect the uptake of FARM products (Miranda and Farrin 2012;Binswanger-Mkhize 2011).…”

Section: First-level Outcomesmentioning

confidence: 99%

Understanding financial agricultural risk for smallholder farmers in developing countries what do we know and not know?

Barooah¹,

Kaushish²,

Puri³

et al. 2017

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The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding and producing high-quality evidence of what works, how, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people's lives. 3ie evidence gap map reports 3ie evidence gap maps are thematic collections of information about impact evaluations or systematic reviews that measure the effects of international development policies and programmes. The maps provide a visual display of completed and ongoing systematic reviews and impact evaluations in a sector or sub-sector, structured around a framework of interventions and outcomes.The evidence gap map reports provide all the supporting documentation for the maps, including the background information for the theme of the map, the methods and results, protocols, and the analysis of results. About this evidence gap map reportThis report provides the supporting documentation for the 3ie evidence gap map on financial risk in agricultural production for smallholder farmers in developing countries, developed as part of a project funded by UK aid through Department for International Development. All of the content of this report is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its Board of Commissioners. Any errors and omissions are also the sole responsibility of the authors. Any comments or queries should be directed to the corresponding author Bidisha Barooah at bbarooah@3ieimpact.org. AcknowledgementsWe are thankful to the UK Department for International Development for supporting this study through 3ie's agricultural risk window. We are also thankful to the numerous interviewees and stakeholders to whom we spoke and from whom we took advice. Arundhati Srinivasan and Megha Nath provided excellent research assistance. Last but not least, we thank Ombeline de Bock, Jesse D'Anjou and Tatiana Goetghebuer from ADE Consulting, who contributed to the sections on theory of change.ii SummaryRisks in agricultural production pose a major threat to the economic well-being and development of households in rural areas of developing countries. Indeed, 98 per cent of the world's food-insecure people live in developing countries, and four in five of them are involved in small-scale food production (Food and Agriculture Organisation et al. 2015). A key reason for this is the inability of the smallholder farmer to mitigate, diversify and transfer risks.To deal with shocks and risks that lead to crop and livestock loss, many organisations around the world have proposed, piloted and implemented financial agricultural risk mitigation (FARM) programmes. In this paper, we identify such programmes and strategies and assess the evidence on their effectiveness. Despite the increasing popularity of these programmes, it is unclear whether FARM instruments improve farmer welfare, provide rea...

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Community health insurance in Uganda: Why does enrolment remain low? A view from beneath

Cited by 125 publications

References 16 publications

Who enrols in voluntary micro health insurance schemes in low-resource settings? Experience from a rural area in Bangladesh

Who enrols in voluntary micro health insurance schemes in low-resource settings? Experience from a rural area in Bangladesh

Perceptions of Care, Socio-Demographic Characteristics and Health Care Utilisation among Health Insurance users in Ghana

Understanding financial agricultural risk for smallholder farmers in developing countries what do we know and not know?

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