Ataklti Gessesse Teka*, Mulugeta Tilahun Gebremidhi, Mulugeta Woldu Abrha, Alemnesh Abrha, Fana Gebreslasie, Asfawesen Aregay, Kiros Fenta, Brhane Ayele and Tsegay Hadgu
Dependence on out-of-pocket payment (OPP) for healthcare may lead poor households to undertake catastrophic health expenditure; millions of people suffer and die because they do not have the money to pay for healthcare. Worldwide about 44 million households face financial problems due to healthcare expenditure; more than 40% of African nations’ health expenditure comes from out-of-pocket payments making a scarcity of funds for health, and lowincome groups make health payments by borrowing or selling property. Therefore, an agenda for developing a system of healthcare financing is common for all nations toward universal health coverage (UHC), using the emerging concept of community-based health insurance (CBHI) as a potential strategy to achieve universal health coverage in developing countries by discussing the problem of healthcare financing in low-income countries (LIC), helping to raise revenue, and narrowing the financial gaps of health sectors providing universal health coverage. Despite great efforts to improve accessibility to modern healthcare services in the past two decades, utilization of healthcare services in Ethiopia has remained very low. However, the functions of pooling funds and organizing them are critical for countries’ progress toward UHC.
Objective: This study aimed to assess willingness to pay, explore the mechanism of financial pooling for community-based health insurance, and identify factors associated with households in the Tigray Region, Northern Ethiopia, in 2020.
Method: A community-based, quantitative and qualitative cross-sectional study was conducted from September to October 2020 in Tigray, Ethiopia. The sample size was determined using a single population proportion formula. Multi-stage cluster sampling was used to select 845study participants and 10 KII and 4FGDs were selected using a purposive sampling technique. Data were collected using an interviewer-administered questionnaire that was managed and analyzed using Epi-data Version 3.5.1 and SPSS Version 21.Theinterview guide used Atlas-ti software for qualitative data.
Results: Based on 845 households surveyed, more than half of respondents, 483 (57.2%), were female. The majority of the respondents, 743(87.9%), knew the current premium and registration fee of community-based health insurance (CBHI), with more than 90 percent, 790(93.5%), planning to renew/enroll their membership in CBHI, with the mean premium per household head they were willing to pay being 396 ETB (SD=±216) and 310 ETB (SD=±115) per household annually for urban and rural, respectively. In addition, six out of ten (62%) urban dwellers and five out of ten (52%) rural dwellers wanted to pay an additional amount of money to the current governmental premium threshold (which is 240 ETB for rural and 350 ETB for urban).
Conclusion: Community-based health insurance is an effective means of increasing the utilization of healthcare services and providing a scheme for member households with a pool mechanism situated at the district level, enabling districts to own the scheme, a decentralized health system, and decentralized decisions, ensuring equity. To alleviate deficits and make CBHI increases in the annual premium and enrollment of the community to CBHI sustainable, budget subsidization by the government to reverse the ruin, increased community awareness, and continuing the current pooling mechanism at the district level, but establishing or revising a department at the health office that controls the process of CBHI, are recommended.
Published Date: 2023-11-22; Received Date: 2023-10-10
