Impact of conditional cash transfers on enrolment in community-based health insurance among female-headed households in south Gondar zone, Amhara region, Ethiopia

Abstract

Ethiopia has been implementing its flagship social protection programme, Productive Safety Net Programme (PSNP), since 2005, mainly in drought prone and chronically food insecure woredas. In 2011, the country also launched Community-Based Health Insurance (CBHI). However, the two large-scale social protection programmes are not integrated well. This study examines the impact of participation in the conditional cash transfer (CCT) component of the PSNP (Public Works or PW) on enrolment in the CBHI among female-headed households in Amhara region. Data for the study generated through a cross-sectional survey collected from 365 PW-participating and non-participating female-headed households in south Gondar zone, Ebinat woreda (district). Inverse-probability-weighted regression adjustment (IPWRA) estimator is used to evaluate the impact of participating in PW component on CBHI enrolment decisions. Enrolment in CBHI among female-headed households is 63.6%. Data also show that 61.2% of insured and 27.1% of non-insured households receive CCTs. The study finds that participating in PSNP's CCT component increases the probability of CBHI enrolment among female-headed households by 16.3 percentage points. The finding informs efforts in integrating social protection programmes among most vulnerable households in rural Ethiopia. It also gives useful insights on the role of PSNP's CCT component to achieving universal health coverage through increasing insurance enrolment among most vulnerable households in Ethiopia.

The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia

“…Households who received cash of food from the safety net program had a significant positive effect on CBHI scheme enrollment. This study was in line with [ 35 – 37 ], which shows that participating in the safety net program increases the probability of CBHI uptake. The justification might be that the poor households prefer to join CBHI because they could not afford the expensive out-of-pocket payment or the CBHI premium was waived due to their poverty status.…”

Factors affecting community-based health insurance utilization among households in Degadamot District, Ethiopia: Community-based cross sectional study

“…In this study, those enrolled in the safety net program had 2.80 times more likely CBHI utilization when compared to those who had not enrolled. The nding is consistent with a study in Ethiopia [30,34,35,36] and Nigeria [37]. It demonstrates that taking part in the safety net program increases the likelihood of taking CBHI.…”

Impact of community-based health insurance on health services utilisation among vulnerable households in Amhara region, Ethiopia

“…Moreover, since enrolment into Ethiopia’s CBHI is voluntary, the poorest non-PSNP households may still be excluded from the programme. A recent study in one of the study districts also finds that extremely poor and most vulnerable households to extreme poverty who are not receiving conditional cash transfers are less likely to join CBHI [ 60 ]. To place CBHI better as a tool towards UHC, the government may implement more measures such as universal eligibility for insurance with a substantial premium subsidy and the universal individual-level exemption for some vulnerable groups such as pregnant women from paying premiums [ 61 ].…”