Abstract:
Abstract
Background: Community based health insurance is one of the ways to moving
towards the goal of universal healthcare coverage, which is a situation where the
whole population of a country has access to appropriate healthcare services. Globally,
about 100 million people suffer a financial catastrophe of ill-health annually and are
pushed below the poverty line. Although evidence in Ethiopia showed for high
willingness to this scheme use, there is high non-enrolment rate in some part of
Amhara region and limited study in Oromia zone.
Objective: To assess the determinant factors of enrolment status of households for
community-based health insurance in Artuma-fursi woreda, Oromia zone, Amhara
region, Ethiopia.
Methods: Community based quantitative cross-sectional study design was used. By
using systematic sampling, 599 households were participated from Jun 23 to July-24,
2020. The data were entered in to EpiData and exported to SPSS version 24 for
analysis. The data were analyzed by logistic regression using 95% confidence level
and variables that have P-value less than 0.2 in bivariable analysis were taken as
candidate variables for multivariable analysis. P-value less than 0.05 and multi
variable analysis model was used to identify the associated factors.
Results: Among the total respondents 50.4% (95% CI; 46.3%-54.5%) participants
were CBHI members. This study revealed that, participation in social organization
(AOR: 2.9; 95% CI: 1.41-5.96), 4-6 family size (AOR: 2.55; 95% CI: 1.19-5.47), >6
family size (AOR: 6.35; 95% CI: 2.86-14.11), history of past illness (AOR:4.29; 95%
CI: 2.34-7.84), rating medium family health status (AOR: 2.33; 95% CI: 1.23-4.42),
rating poor family health status (AOR: 2.30; 95% CI: 1.08-4.88), participation in
productive safety net (AOR: 6.04; 95% CI: 3.0-12.17), poor wealth status (AOR: 3.36;
95% CI: 1.44-7.86), medium wealth status (AOR: 4.24; 95% CI: 1.79-10.05), rich
wealth status (AOR: 4.78; 95% CI: 2.05-11.15), choosing public health facility (AOR:
9.45; 95% CI: 5.38-19.6), choosing traditional healers (AOR: 4.81; 95% CI: 1.2418.66),
affordable
premium
(AOR:
3.28;
95%
CI:
1.47-7.31)
and
adequate
knowledge
(AOR:
2.96;
95%
CI:
1.74-5.02)
were
significantly
associated
with
enrolment
status.
Conclusion: This study revealed that CBHI enrolment is relatively low. Participation
in social organization, family size, history of illness, rating medium and poor family
health status, participation in productive safety net program, being rich, choice of
1
public health facility and traditional healers, premium affordability and adequate
knowledge were the major significant factors. Therefore, mobilizing and creation of
awareness for the community to pool large risk and facilitating government or donors
fund to subsidizing premium for poorest house hold.
Key Words: Determinants, Enrolment status, Community based health insurance.
