PREVALENCE AND DETERMINANTS OF ENROLMENT STATUS FOR COMMUNITY BASED HEALTH INSURANCE IN ARTUMA FURSI WOREDA, AMHARA REGION, NORTHEAST ETHIOPIA, 2020

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.