Communitybased health insurance and outofpocket healthcare spending in africa. It is being piloted in the sheko district, but community satisfaction with the scheme has not yet studied. Communitybased health insurance and outofpocket healthcare. Unmatched casecontrol study was conducted on 148 cases memberto insurance and 148 controls notmemberto insurance program from september 1 to october 30,2016.
Cbhi is currently being provided in some rural areas in developing countries and there is ongoing research about its impact on the wellbeing of the. Community based health insurance schemes mutuelles in rwanda are one of the largest experiments in community based risksharing mechanisms in subsaharan africa for health related problems. Determinants of enrollment decision in the communitybased. This study was conducted to assess the willingness to pay. Voluntary vs mandatory universal 12 pilot districts in four regions 4 control districts one from each regions pilot design. The development of communitybased health insurance in. Evaluation of communitybased health insurance pilot. Community based health insurance schemes cbhi provided also a platform for the compilation of information to support the assessment of cbhi schemes, and to familiarize health sector actors, and partners with the strategies needed to support their implementation on a large scale. The development of community based health insurance in rwanda.
That scheme is communitybased health insurance or cbhi. Background community based health insurance cbhi is becoming a prominent and promising concept in tackling financial health care issues confronting the poor rural communities in developing countries. Social health insurance shi is a formal sector affordable only for rich people. Open access research communitybased health insurance. Community based health insurance in ethiopia participedia. In 2011, in an attempt to increase access to health care and reduce household vulnerability to outofpocket health expenditure, the government of ethiopia launched a community based health. These include working with the ethiopian health insurance agency to implement and expand communitybased health insurance cbhi and social health insurance schemes. Therefore, communitybased health insurance cbhi has become part of an overall health financing strategy in a number of countries, several governments in these countries have embraced communitybased health financing with national policies and administrative support to the implementation of a number of cbhi for improving utilization of health. Ethiopian health insurance agency, abt associates inc. Ethiopia national health insurance scaleup assessment on. Box 8, sodo, ethiopia 1 department of health services management 2. Pdf enrollment in ethiopias communitybased health insurance. Therefore, this study aimed to assess the experiences and satisfaction of households enrolled.
Community based health insurance schemes partially fulfill the ethiopian governments long term goal of improving healthcare by mobilizing domestic resources, improving access to healthcare services, and increasing the quality of services provided. Therefore, social and community based health insurance schemes were introduced since 2010. As a prelude to national coverage, in june 2011, the ethiopian. Abt has been the lead partner supporting ethiopias implementation of healthcare financing reforms both at all government levels and at healthfacility levels. Low contract renewal rates have been identified as one of the challenges facing the development of communitybased health insurance cbhi schemes.
This paper discusses various aspects of community based health insurance cbhi. Community based health insurance schemes are becoming increasingly recognized as a tool to finance health care in developing countries. The data was collected from a random sample of 210 households from three communitybased organizations, locally known as. Impact of ethiopian pilot communitybased health insurance.
Household satisfaction with a communitybased health. Social health insuranceshi is a formal sector affordable only for rich people. Community based health insurance schemes are becoming recognized as powerful method to achieve universal health coverage and reducing the financial catastrophic shock of the community. Therefore, this study aimed to assess willingness to pay for communitybased health insurance and associated factors among rural households of bugna district. Experiences and lessons context c ommunity based health insurance cbhi is much debated as a way of tackling the challenge of providing access to health care for the poor in developing countries without worsening their economic situation. The ethiopian health insurance agency ehia has been steadily preparing for the implementation of social health insurance shi for the formally employed sector. Experiences and lessons 7 executive summary rwanda has been recognized as having the most successful community based health insurance cbhi scheme in subsaharan africa and, indeed, one of the most successful in the world.
Community based health insurance cbhi schemes in many developing countries emanates partly from a need to provide financial protection against unexpected health care costs and to enhance access to modern health care. Evidence from rwanda in the absence of third party and prepayment systems such as health insurance and taxbased healthcare financing, households in many lowincome countries are exposed to the financial risks of paying large medical bills from outofpocket. The ethiopian government is now implementing communitybased health insurance for citizens in the informal and agriculture sectors as a pilot basis. Ethiopias communitybased health insurance scheme has the potential to help the country achieve universal health coverage. Community based health insurance in developing countries. Community based health insurance scheme as a new healthcare financing approach in rural ethiopia.
This evidence is analyzed using a simple framework that is presented in section 3. Prepaid plans for health are not accustomed in ethiopia. Evaluation of community based health insurance pilot schemes in ethiopia. Communitybased health insurance program in ethiopia. Communitybased health insurance and healthcare service. Effect of communitybased health insurance on utilization of. Background communitybased health insurance cbhi is becoming a prominent and promising concept in tackling financial health care issues confronting the poor rural communities in developing countries. Communitybased health insurance schemes mutuelles in rwanda are one of the largest experiments in community based risksharing mechanisms in subsaharan africa for health related problems. Abt provided technical support for a communitybased health insurance cbhi pilot in woredas. The impact of ethiopias pilot community based health.
Experiences and lessons 7 executive summary rwanda has been recognized as having the most successful communitybased health insurance cbhi scheme in subsaharan africa and, indeed, one of the most successful in the world. Following a threeyear evaluation of piloting communitybased health insurance cbhi schemes for the informal sector, these will be scaled up to cover 80% of the communities. In july 2011, the government of ethiopia launched a pilot community based health insurance cbhi scheme, with the aim of enhancing access to health care and reducing the burden of oop expenditure. Evaluation of communitybased health insurance pilot schemes in ethiopia.
In an effort to do so, empirical evidence is drawn from various countries, including india, on their experiences of implementing cbhi schemes and possible applications to india, problems and challenges faced and the policy and manage. Communitybased health insurance cbhi scheme is an emerging alternative to increase primary healthcare access. Willingness to join communitybased health insurance among. Sep 19, 2019 in 2011, the government of ethiopia introduced a communitybased health insurance cbhi program and implemented it using a phasedin approach. Rwanda and ethiopia operate a communitybased health insurance cbhi programme, but rwandas cbhi system cbhis is mandatory table 1. Community based health insurance schemes cbhis apply the principles of insurance to the social context of communities, guided by their preferences and based on their structures and arrangements.
Pdf community based health insurance scheme as a new. Community based health insurance schemes are becoming recognized as powerful. Evaluation of communitybased health insurance pilot schemes. Ethiopia endorsed and constituted cbhi schemes in pilot woredas in 201011. Community based health insurance cbhi schemes are an emerging tool for providing financial protection against health related poverty.
Bmc res notes household satisfaction with a community based health insurance scheme in ethiopia abebe sorsa badacho 0 2 kora tushune 1 2 yohannes ejigu 1 2 tezera moshago berheto 0 2 0 school of public health, college of health sciences, wolaita sodo university, p. Pdf household satisfaction with a communitybased health. Communitybased health insurance schemes cbhis apply the principles of insurance to the social context of communities, guided by their preferences and based on their structures and arrangements. In 2011, in an attempt to increase access to health care and reduce household vulnerability to outofpocket health expenditure, the government of ethiopia launched a communitybased health. The types of vulnerability prevalent in ethiopia include agricultural vulnerability, natural. Pdf communitybased health insurance and communities. To select the villages and households, stratified then.
Among others, the aims of the scheme are to increase access to health care and to reduce household vulnerability to unexpected outofpocket health expenditure. Therefore, this study aimed to assess the experiences and satisfaction of households enrolled in a pilot cbhi scheme. A step on the road to universal health coverage executive summary e thiopia has been implementing communitybased health insurance cbhi schemes as pilots since 2011 with the objective of drawing lessons for eventual scaleup countrywide. This study aimed to assess the compliance of the community to cbhi scheme. Teodros bekele md, fmoh, ethiopia cape town, south africa december 2009 community based health insurance scheme. A step on the road to universal health coverage executive summary. In the next section, we return to the issue of chi as a response to obstacles to the implementation of universal coverage. Bmc res notes household satisfaction with a communitybased health insurance scheme in ethiopia abebe sorsa badacho 0 2 kora tushune 1 2 yohannes ejigu 1 2 tezera moshago berheto 0 2 0 school of public health, college of health sciences, wolaita sodo university, p. Nigeria has included a regulated communitybased health insurance cbhi model within its national health insurance scheme nhis. That led to a national program targeting 80 percent of ethiopias informal sector. Ethiopia scales up communitybased health insurance hfg. Socioeconomic status does not inhibit uptake and foodinsecure households are more likely to enroll. Effect of communitybased health insurance on utilization.
Impact of ethiopias community based health insurance on. Community based health insurance scheme as a new healthcare. The ethiopian government is now implementing community based health insurance for citizens in the informal and agriculture sectors as a pilot basis. Background communitybased health insurance cbhi scheme is an emerging strategy for providing financial protection against healthrelated poverty. Community based health insurance and outofpocket healthcare spending in africa. Communitybased health insurance in developing countries. Communitybased health insurance schemes are becoming increasingly recognized as a tool to finance health care in developing countries. In 2011, a pilot cbhi scheme was introduced in ethiopia. The program was first piloted in 201120, within woredas districts of the four most populous regions. Chi is a common denominator for voluntary health insurance schemes, organized at the level of the community, that are labelled alternatively as mutual health organizations atim 1999. In this study, willingness of rural households in debub bench district, to.
Tanzania and kenya have separate insurance schemes for the formal and informal sectors. Following a threeyear evaluation of piloting community based health insurance cbhi schemes for the informal sector, these will be scaled up to cover 80% of the communities. To identify the determinants for enrollment decision in the communitybased health insurance program among informal economic sectorengaged societies, north west ethiopia. In this paper, we look at how community based health insurance schemes chis have been performing in practice so far. Based on a fixed effects analysis of household panel data, this paper assesses the impact of the scheme on utilization of modern healthcare and the cost of accessing healthcare. Jan 24, 2019 community based health insurance schemes are becoming recognized as powerful method to achieve universal health coverage and reducing the financial catastrophic shock of the community. Therefore, this study aimed to assess the level of households satisfaction to cbhi scheme and associated factors in a piloted sheko. Willingness to pay for community based health insurance. Nigeria has included a regulated community based health insurance cbhi model within its national health insurance scheme nhis. Cbhi is currently being provided in some rural areas in developing countries and there is ongoing research about its. Role on access, use and quality of healthcare services, the case of tehuledere district, south.
Objectives the objective of this study was to compare differences in healthcare utilisation between communitybased health insurance member households and nonmember households and to identify factors for communitybased health insurance enrolment in south achefer district. Cbhi is health insurance that pools members premium payments into a collective fund, which is managed by the members, and covers basic health care costs at local health centers when a member is sick. Therefore, this study aimed to assess the level of households satisfaction to cbhi scheme and associated factors. The project has achieved high levels of citizen engagement. May 31, 2015 as part of its health care financing strategy in general and its health insurance strategy in particular, the government of ethiopia endorsed and launched community based health insurance cbhi schemes in pilot woredas in amhara, oromia, southern nations, nationalities, and peoples snnp, and tigray regions in 201011 to provide risk. Communitybased health insurance programmes and the national. Communitybased health insurance cbhi schemes are an emerging tool for providing financial protection against healthrelated poverty.
Feb 25, 2020 mebratie a, sparrow r, yilma z, abebaw d, alemu g, bedi a. Social health insurance schemes in africa leave out the. Feb 21, 2014 nigeria has included a regulated community based health insurance cbhi model within its national health insurance scheme nhis. The development of communitybased health insurance in rwanda. Communitybased health insurance and social capital. In june 2011, the ethiopian government launched a community based health insurance scheme. Communitybased health insurance schemes are becoming. In july 2011, the government of ethiopia launched a pilot communitybased health insurance cbhi scheme, with the aim of enhancing access to health care and reducing the burden of oop expenditure. Communitybased health insurance programmes and the.
A study on the impact of ethiopias pilot cbhi scheme on healthcare utilization. In ethiopia, inpatient healthcare utilisation was 6%, which is one of the lowest health. Communitybased health insurance schemes cbhi provided also a platform for the compilation of information to support the assessment of cbhi schemes, and to familiarize health sector actors, and partners with the strategies needed to support their implementation on a large scale. But a new form of idirkire nicknamed edirkire while alive is gaining traction as the ethiopian government pursues its goal of providing universal health coverage. The health sector development plan iv moh 2010 estimates life expectancy at birth in ethiopia at 54 years 53. Community based health insurance cbhi is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for lowincome rural households who are excluded from formal insurance. In most developing countries, healthcare cost is mainly paid at the time of sickness and outofpocket at. Communitybased health insurance cbhi is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for lowincome rural households who are excluded from formal insurance.
This study aimed to assess the compliance of the community to cbhi scheme requirements in thehuledere district. Mebratie and others published enrollment in ethiopias communitybased health insurance scheme find. In ethiopia opp accounts 37% of the total spending in health care. Dropping out of ethiopias communitybased health insurance. Box 8, sodo, ethiopia 1 department of health services management 2 college of public health and medicine.
In recent years, there has been a proliferation of communitybased health insurance cbhi schemes designed to provide financial protection against the costs of health care and expand access to modern healthcare services to the informal and rural sectors. Conceptual framework for household satisfaction with a communitybased health insurance scheme in ethiopia developed from 3, 16, 17, 19, 22. In ethiopia, cbhi is being piloted in districts, but community experience and satisfaction with the scheme have yet to be studied. Determinants of communitybased health insurance implementation in west gojjam zone, northwest ethiopia. Unmatched casecontrol study was conducted on 148 cases membertoinsurance and 148 controls notmembertoinsurance program from september 1 to october 30,2016.
In 2011, the government of ethiopia introduced a communitybased health insurance cbhi program and implemented it using a phasedin approach. The purpose of this study was to assess factors that determine decisions to join the community based health insurance in west gojjam zone. These include working with the ethiopian health insurance agency to implement and expand community based health insurance cbhi and social health insurance schemes. In june 2011, the government of ethiopia introduced a pilot community based health insurance cbhi scheme in rural parts of the country. In ethiopia, there is an old tradition called idir or kire of community organizations providing financial help to families for emergencies, like funerals. Mebratie and others published enrollment in ethiopia s communitybased health insurance scheme find, read and cite all the research you need on researchgate. Community based health insurance schemes in developing. Evidence from rwanda in the absence of third party and prepayment systems such as health insurance and tax based healthcare financing, households in many lowincome countries are exposed to the financial risks of paying large medical bills from outofpocket. The scheme, which caters to rural households and urban informal sector workers, was rolled out in districts located in four main regions tigray. This article uses longitudinal household survey data gathered in 2012 and 20 to examine dropout in the case of ethiopias pilot cbhi scheme. Cbhis can help communities manage healthcare costs and provide access to basic healthcare for the poor and other vulnerable groups. As part of its health care financing strategy in general and its health insurance strategy in particular, the government of ethiopia endorsed and launched communitybased health insurance cbhi schemes in pilot woredas in amhara, oromia, southern nations, nationalities, and peoples snnp, and tigray regions in 201011 to provide risk. Pdf impact of ethiopias community based health insurance. A study on the feasibility of health insurance schemes for community based groups in addis ababa city israel fekade zewde1 abstract this study analyzes households willingness to pay wtp for a new health insurance scheme.
To identify the determinants for enrollment decision in the community based health insurance program among informal economic sectorengaged societies, north west ethiopia. Social health insurance schemes in africa leave out the poor. Community based health insurance schemes in developing countries. Communitybased health insurance and communities scheme. Willingness to pay for community based health insurance among.
In mid2011, the government of ethiopia launched a pilot community based health insurance cbhi scheme in thirteen rural districts. The sih system doesnt include 85% poorest society of ethiopian living in a rural area, so i have given attention to cbhi. Enrollment in ethiopias communitybased health insurance. Willingness to pay for communitybased health insurance and. The projects goal was to examine how the communitybased health insurance cbhi scheme has affected healthcare utilisation and outofpocket health spending. Household satisfaction with communitybased health insurance. Willingness to pay for communitybased health insurance. This study examines the impact of the program on demand for modern health care, mitigation of outof.
932 1502 342 1314 1230 1501 474 462 326 586 992 1454 280 1358 1153 188 15 1267 1464 471 1128 1063 844 1450 1247 1276 1055 797 1147 1547 628 775 1489 956 225 855 168 1324 754