Determinants of Enrolment for Community Based Health Insurance Scheme among Agro-pastoralist communities of Aw-barre District in Somali region of Ethiopia: Unmatched  case control study.

Elmi, Abdifatah; Oladeji, Olusola; Robins, Ann; Tahir, Ahmed

doi:10.21203/rs.3.rs-921599/v1

Cited by 1 publication

(5 citation statements)

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“…The studies were conducted from 2017 to 2022. Regarding the distribution of the studies across the region, five were from Amhara [ 40 , 41 , 43 , 45 , 47 ], four from Oromia [ 34 , 35 , 44 , 46 ], two from Sidama [ 39 , 42 ], one from Somali [ 37 ], one from Southern Nations, Nationalities, and Peoples’ Region (SNNPR) [ 36 ], and two from Addis Ababa [ 38 , 48 ]. In all of the studies, data was collected by a face-to-face interview using a pretested, interviewer-administered questionnaire ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…The effect of affordability (people’s ability to pay) for CBHI enrollment was assessed using the findings of five studies [ 35 , 37 , 42 , 46 , 47 ]. Compared to their counterparts, individuals who thought that the CBHI premium payment was affordable were 2.58 times more likely to enrol in the scheme (OR = 2.58, 95% CI: 1.68, 3.47) ( Fig 7 ).…”

Section: Resultsmentioning

confidence: 99%

“…Fifteen studies (11 cross-sectional and 4 case-control) with a total of 8418 study participants were considered [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. Both the minimum (n = 262) [41] and the maximum(n = 1014) [43] sample size were from the Amhara region.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Five variables were found to be determinants of CBHI enrolment: affordability of payment for the scheme, knowledge of respondents on the CBHI scheme, perceived quality of service, trust in the scheme, and presence of a person with chronic disease in the household. The effect of affordability (people's ability to pay) for CBHI enrollment was assessed using the findings of five studies [35,37,42,46,47]. Compared to their counterparts, individuals who thought that the CBHI premium payment was affordable were 2.58 times more likely to enrol in the scheme (OR = 2.58, 95% CI: 1.68, 3.47) (Fig 7).…”

Section: Determinants Of Enrolment In the Cbhi Scheme In Ethiopiamentioning

confidence: 99%

“…A total of nine studies were included to identify the association between the knowledge of the respondents on and their enrolment in the CBHI scheme [36,37,42,43,[45][46][47][48]. According to the random-effect meta-analysis, respondents with adequate knowledge of the CBHI scheme were 4.35 times more likely to enroll in the CBHI scheme than those with inadequate knowledge(OR = 4.35, 95% CI: 2.69, 6.01) (Fig 8).…”

Section: Determinants Of Enrolment In the Cbhi Scheme In Ethiopiamentioning

confidence: 99%

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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

Habte¹,

Tamene²,

Ejajo³

et al. 2022

PLoS ONE

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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.

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