Role on access, use and quality of healthcare services, the case of tehuledere district, south. Community based health insurance schemes in africa. 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. In june 2011, the ethiopian government launched a community based health insurance scheme. Community based health insurance cbhi schemes are an emerging tool for providing financial protection against health related poverty. To select the villages and households, stratified then. In 2011, a pilot cbhi scheme was introduced in ethiopia. 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. 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. Voluntary vs mandatory universal 12 pilot districts in four regions 4 control districts one from each regions pilot design. 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 community based health insurance for citizens in the informal and agriculture sectors as a pilot basis.
Mebratie and others published enrollment in ethiopia s communitybased health insurance scheme find, read and cite all the research you need on researchgate. Background community based health insurance scheme. Box 8, sodo, ethiopia 1 department of health services management 2. Communitybased health insurance programmes and the national. Rwanda and ethiopia operate a communitybased health insurance cbhi programme, but rwandas cbhi system cbhis is mandatory table 1. 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.
The project has achieved high levels of citizen engagement. 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. Low contract renewal rates have been identified as one of the challenges facing the development of communitybased health insurance cbhi schemes. Community based health insurance scheme as a new healthcare. 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. Determinants of enrollment decision in the communitybased. The total economic cost of illness for households is also estimated to be frequently above 10% of household income which is categorized as catastrophic. Background communitybased health insurance cbhi scheme is an emerging strategy for providing financial protection against healthrelated poverty.
The health sector development plan iv moh 2010 estimates life expectancy at birth in ethiopia at 54 years 53. Sep 19, 2019 in 2011, the government of ethiopia introduced a communitybased health insurance cbhi program and implemented it using a phasedin approach. 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. 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. In ethiopia, there is an old tradition called idir or kire of community organizations providing financial help to families for emergencies, like funerals. 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. Pdf enrollment in ethiopias communitybased health insurance. Community based health insurance in ethiopia participedia. This evidence is analyzed using a simple framework that is presented in section 3. Social health insuranceshi is a formal sector affordable only for rich people. To identify the determinants for enrollment decision in the community based health insurance program among informal economic sectorengaged societies, north west ethiopia. 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. In most developing countries, healthcare cost is mainly paid at the time of sickness and outofpocket at. Community based health insurance scheme as a new healthcare financing approach in rural ethiopia.
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. Enrollment in ethiopias communitybased health insurance. Ethiopia endorsed and constituted cbhi schemes in pilot woredas in 201011. Pdf household satisfaction with a communitybased health. 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. That scheme is communitybased health insurance or cbhi.
Cbhis can help communities manage healthcare costs and provide access to basic healthcare for the poor and other vulnerable groups. Community based health insurance and outofpocket healthcare spending in africa. Evaluation of communitybased health insurance pilot schemes in ethiopia. Willingness to join communitybased health insurance among. Household satisfaction with communitybased health insurance. Conceptual framework for household satisfaction with a communitybased health insurance scheme in ethiopia developed from 3, 16, 17, 19, 22. Therefore, this study aimed to assess willingness to pay for community based health insurance and associated factors among rural households of bugna district, ethiopia. This study aimed to assess the compliance of the community to cbhi scheme. This paper discusses various aspects of community based health insurance cbhi. 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 communitybased health insurance cbhi scheme, with the aim of enhancing access to health care and reducing the burden of oop expenditure. Teodros bekele md, fmoh, ethiopia cape town, south africa december 2009 community based health insurance scheme. Therefore, this study aimed to assess willingness to pay for communitybased health insurance and associated factors among rural households of bugna district. Community based health insurance schemes are becoming recognized as powerful. The development of communitybased health insurance in rwanda. The ethiopian health insurance agency ehia has been steadily preparing for the implementation of social health insurance shi for the formally employed sector. Willingness to pay for communitybased health insurance and. 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. Household satisfaction with a communitybased health. 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. 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. In the next section, we return to the issue of chi as a response to obstacles to the implementation of universal coverage.
Communitybased health insurance and social capital. These include working with the ethiopian health insurance agency to implement and expand communitybased health insurance cbhi and social health insurance schemes. Communitybased health insurance schemes are becoming. Evaluation of community based health insurance pilot schemes in ethiopia. Dropping out of ethiopias communitybased health insurance. 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. This study examines the impact of the program on demand for modern health care, mitigation of outof. Ethiopias communitybased health insurance scheme has the potential to help the country achieve universal health coverage. 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. Social health insurance schemes in africa leave out the. Feb 25, 2020 mebratie a, sparrow r, yilma z, abebaw d, alemu g, bedi a. These include working with the ethiopian health insurance agency to implement and expand community based health insurance cbhi and social health insurance schemes. Communitybased health insurance cbhi schemes are an emerging tool for providing financial protection against healthrelated poverty.
Community based health insurance schemes in developing. Therefore, this study aimed to assess the level of households satisfaction to cbhi scheme and associated factors in a piloted sheko. The types of vulnerability prevalent in ethiopia include agricultural vulnerability, natural. The ethiopian government is now implementing communitybased health insurance for citizens in the informal and agriculture sectors as a pilot basis. Unmatched casecontrol study was conducted on 148 cases membertoinsurance and 148 controls notmembertoinsurance program from september 1 to october 30,2016. Abt provided technical support for a communitybased health insurance cbhi pilot in woredas.
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. 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. In this study, willingness of rural households in debub bench district, to. 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. Determinants of communitybased health insurance implementation in west gojjam zone, northwest ethiopia. The development of communitybased health insurance in. Communitybased health insurance and communities scheme. Evaluation of communitybased health insurance pilot. The impact of ethiopias pilot community based health. Mebratie and others published enrollment in ethiopias communitybased health insurance scheme find. Impact of ethiopias community based health insurance on. The purpose of this study was to assess factors that determine decisions to join the community based health insurance in west gojjam zone.
Communitybased health insurance program in ethiopia. The sih system doesnt include 85% poorest society of ethiopian living in a rural area, so i have given attention to cbhi. 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 data was collected from a random sample of 210 households from three communitybased organizations, locally known as. Box 8, sodo, ethiopia 1 department of health services management 2 college of public health and medicine.
Impact of ethiopian pilot communitybased health insurance. Socioeconomic status does not inhibit uptake and foodinsecure households are more likely to enroll. Ethiopia scales up communitybased health insurance hfg. Therefore, this study aimed to assess the experiences and satisfaction of households enrolled in a pilot cbhi scheme. Therefore, social and community based health insurance schemes were introduced since 2010. To identify the determinants for enrollment decision in the communitybased health insurance program among informal economic sectorengaged societies, north west ethiopia. 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.
Communitybased health insurance and healthcare service. 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. The scheme, which caters to rural households and urban informal sector workers, was rolled out in districts located in four main regions tigray. Therefore, this study aimed to assess the experiences and satisfaction of households enrolled. In this paper, we look at how community based health insurance schemes chis have been performing in practice so far. Ethiopian health insurance agency, abt associates inc. Ethiopia national health insurance scaleup assessment on. Communitybased health insurance schemes are becoming increasingly recognized as a tool to finance health care in developing countries. That led to a national program targeting 80 percent of ethiopias informal sector. 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. Abt has been the lead partner supporting ethiopias implementation of healthcare financing reforms both at all government levels and at healthfacility levels. In ethiopia, cbhi is being piloted in districts, but community experience and satisfaction with the scheme have yet to be studied. 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 in developing countries. Communitybased health insurance in developing countries. Communitybased health insurance programmes and the. Social health insurance schemes in africa leave out the poor. Willingness to pay for community based health insurance. Evaluation of communitybased health insurance pilot schemes. The projects goal was to examine how the communitybased health insurance cbhi scheme has affected healthcare utilisation and outofpocket health spending. 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.
Community based health insurance schemes in developing countries. The program was first piloted in 201120, within woredas districts of the four most populous regions. Nigeria has included a regulated community based health insurance cbhi model within its national health insurance scheme nhis. This article uses longitudinal household survey data gathered in 2012 and 20 to examine dropout in the case of ethiopias pilot cbhi scheme. 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. Prepaid plans for health are not accustomed in ethiopia. Willingness to pay for community based health insurance among. 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. Cbhi is currently being provided in some rural areas in developing countries and there is ongoing research about its. This study was conducted to assess the willingness to pay.
A step on the road to universal health coverage executive summary. 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. Effect of communitybased health insurance on utilization of. Tanzania and kenya have separate insurance schemes for the formal and informal sectors. 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.
Pdf communitybased health insurance and communities. Communitybased health insurance and outofpocket healthcare spending in africa. 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. Willingness to pay for communitybased health insurance.
Social health insurance shi is a formal sector affordable only for rich people. Feb 21, 2014 nigeria has included a regulated community based health insurance cbhi model within its national health insurance scheme nhis. In ethiopia opp accounts 37% of the total spending in health care. Among others, the aims of the scheme are to increase access to health care and to reduce household vulnerability to unexpected outofpocket health expenditure. 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. Pdf impact of ethiopias community based health insurance. In june 2011, the government of ethiopia introduced a pilot community based health insurance cbhi scheme in rural parts of the country.
Therefore, this study aimed to assess the level of households satisfaction to cbhi scheme and associated factors. The development of community based health insurance in rwanda. 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. 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. As a prelude to national coverage, in june 2011, the ethiopian. Open access research communitybased health insurance.
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. Community based health insurance schemes are becoming increasingly recognized as a tool to finance health care in developing countries. Communitybased health insurance cbhi scheme is an emerging alternative to increase primary healthcare access. 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.
Nigeria has included a regulated communitybased health insurance cbhi model within its national health insurance scheme nhis. Effect of communitybased health insurance on utilization. In ethiopia, inpatient healthcare utilisation was 6%, which is one of the lowest health. This study aimed to assess the compliance of the community to cbhi scheme requirements in thehuledere district.
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