Pooled coverage of community based health insurance scheme enrolment in Ethiopia, systematic review and meta-analysis, 2016–2020

Abstract

Background Community Based Health Insurance (CBHI) is a type of health insurance program that provides financial protection against the cost of illness and improving access to health care services for communities engaged in the informal sector. In Ethiopia, the coverage of CBHI enrolment varies across regions and decision of household enrolment is affected by different factors. There are pocket studies on CBHI scheme with different coverage in Ethiopia and there is no pooled study on CBHI enrolment coverage in Ethiopia for better understanding the scheme and decision making. The aim of this systematic review and meta-analysis was to identify the pooled coverage of CBHI enrolment in Ethiopia to understand its policy implications. Methods The systematic review and meta-analysis was done by adhering the PRISMA guideline with exhaustive search in PubMed/Medline, HINARI, SCOPUS and Google scholar complemented by manual search. Two authors independently selected studies, extracted data, and assessed quality of studies. The I2 test statistic was used to test heterogeneity among studies. The overall coverage of CBHI scheme was estimated by using random-effects model. Result Among 269 identified, 17 studies were included in this meta-analysis and the overall coverage of CBHI scheme was 45% (95% CI 35%, 55%) in Ethiopia. The sub-group analysis shows higher enrolment rate 55.97 (95%CI: 41.68, 69.77) in earlier (2016–2017) studies than recent 37.33 (95%CI: 24.82, 50.77) studies (2018–2020). Conclusion The pooled coverage of CBHI enrolment is low in Ethiopia compared the national target of 80% set for 2020. It is also concentrated in only major regions of the country. The finding of the study helps national decision making for CBHI scheme service improvement. Due attention to be given to improving geographic expansion of CBHI and to the declining coverages with in the CBHI implementing regions by addressing the main bottlenecks restraining coverages. Trial registration The protocol of this systematic review and meta-analysis was published in PROSPERO with registration number: CRD42021252762.

The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis

“…Based on the concepts of UHC, the qualitative findings of the included studies were thematized into five categories. PC : The PC of the CBHI has gradually been expanded [ 38 , 41 , 42 ]. HSU : CBHI improved HSU [ 36 , 43–56 ], such as antenatal care (ANC) visits [ 43 ]; child healthcare visits [ 44 , 47 ]; seeking treatment for malaria [ 46 ]; in-patient [ 36 ] and outpatient [ 49 , 50 ] attendances; frequency of visits [ 49 , 53 ]; and family planning [ 53 ].…”

“…The pooled UHC by CBHI was found to be 45.6%. Regarding PC, according to the three national studies included in this review, 40.10% of the households were found to be covered by the scheme, with the lowest, medium, and highest coverages being 28% [ 38 ], 45% [ 42 ], and 45.5% [ 41 ], respectively. Coming to the impact of CBHI on HSU, the pooled report of the 13 included studies showed that the HSU among CBHI members was 64.5%.…”

Combining social protection interventions for better food security: Evidence from female-headed households in Amhara region, Ethiopia

“…The CBHI benefit package covers all outpatient and inpatient services at the contracted public health centers and hospitals (through referral system) except dental, optic and cosmetic procedures [24]. Most recent enrollment estimations indicate that about 45-50% of the population is enrolled [25,26]. In 2018, overall CBHI enrolment in the study woreda was 64%.…”