Abstract:
Abstract
Background: Poor informal sector workers and rural residents in Africa had never accessed
adequate social protection related to health insurance program. In Ethiopia a community based
health insurance was established in 2011, to address the health challenges of the poor population.
After scaling up the program, information on the effectiveness and effect of the program on
health service utilization was limited. Therefore the finding of this evaluation will be used by key
stakeholders to decide whether the program is effective or not and provide information about the
program attribution on health service utilization.
Objective: The objective of this study was to evaluate the outcome of community-based health
insurance program on health service utilization, Northwest, Ethiopia, 2021.
Methods: A matched comparison group evaluation design with a sequential explanatory mixedmethod
was employed. The Organization for Economic Cooperation and Development
Framework with effectiveness and impact dimensions were considered. A total of 332
households from the intervention group and 341 comparison households were selected randomly
and used for evaluation. An in-depth interview and key informant interview were conducted to
explore the effectiveness of the program. The qualitative data were recorded, transcribed,
translated, and then thematized for analysis. A structured questionnaire was used for the
effectiveness and impact dimension. The data were entered into Epi Data version 4.6 and
transferred to Stata Version 14 for analysis. The quality of different matching algorithms was
checked using Pstest then kernel matching (bandwidth 0.06) was selected for the estimation of
the treatment effect of enrolling in CBHI program on health service utilization.
Results: The health service utilization rate in the intervention site was found at 1.3. Being in a
treated group increases the health service utilization by 6.9% [ATT= 0.069; 95% CI: 0.034,
0.114]. All key informants and program members agreed that there was health service utilization
improvement after the program contracted with the health facility.
Conclusion: Even though, health service utilization rate is relatively lower as compared to the
stated objective towards the health service utilization (1.6) the overall performance of the CBHI
program towards the health service utilization was good based on the judgment criteria. The
CBHI program is attributed to the health service utilization improvement in the CBHI members.
Keywords: CBHI, Health service utilization, outcome evaluation, Woreta, Dabat, Ethiopia
