Determinants of participation in a community based health insurance scheme in Bambasi Woreda ,Benishangul Gumuz Region.

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Addis Ababa University


Background: Due to the failure of proper healthcare resource allocation and poor affordability to health services, many citizens are exposed to impoverishment from health shocks and catastrophic out of pocket health expenditure. The poorest households even abstain from seeking health care. In order to reverse this scenario and meet universal health coverage, a pilot community based health insurance (CBHI) scheme was launched in Ethiopia in 2011. Objective: The main objective of the study is to examine factors influencing participation in a community based health insurance scheme in Bambasi Woreda of Benishangul Gumuz region. Method: The study was community based cross sectional quantitative type undertaken in Bambasi Woreda of Benishangul gumuz region. Using two–stage sampling technique, 614 sample households were selected and used for the analysis. After the data is fed into Epi Info 3.7.0, STATA 14 software was applied to clean and analyze the data. The data were analyzed by frequency tables, summary statistics and logistic regression model. Results: It is found that 55% of sample households are members of the pilot community based health insurance scheme. 85% of the respondents have information about the recently introduced scheme. The multivariate analysis reveals a number of factors drive enrollment to the scheme. Willingness to join the scheme was more likely among the rich households as compared to the poor (AOR of 95% AOR of CI 2.719(1.144, 6.464). Those who have no awareness on the scheme are less likely to participate than those who have (AOR of 95 % CI (0.051(0.012, 0.212)). Participation to the scheme is also found to be more likely among those who have confidence on commitment of CBHI officials and who accept the benefit packages. Furthermore, illness episode was positivity associated with uptake of CBHI (AOR of 95% CI4.407 (1.802, 10.777) Conclusions &recommendation: It is concluded that awareness, family size, illness episodes, level of income, benefit packages, distance from health facility were factors influencing participation in a CBHI.The Study also indicates the importance of enhancing awareness, create confidence on the commitment of the scheme officials, and make the benefit package according to the expectation of the community in order to boost uptake of CBHI scheme. It is also noted that adverse selection could be a threat to the financial sustainability of the scheme.



Health insurance