The effect of social marketing strategies on community based health insurance enrolment in lideta sub city, Addis Ababa, Ethiopia.
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Date
2021-06
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Addis Abeba University
Abstract
Background: Health insurance system is one of the means to enhance access to health care
services and to protect individuals from catastrophic health expenditures. Social marketing
strategies such as radio, television, print media, facility &community based sensitizations
have been used to augment enrollment in to community-based health insurance (CBHI)
schemes in Ethiopia. However, there is gap of evidence on the influence of existing social
marketing strategies on CBHI enrollment in Ethiopia.
Objectives: This study aims to assess the effect of utilization of social marketing strategies
on households to join CBHI and associated factors with enrollment in Lideta Sub City, Addis
Ababa.
Methods: A cross sectional study was conducted among a sample of 422 randomly selected
households of Lideta sub-city, Addis Ababa in two randomly selected woredas using
structured questionnaires. Epi-data version-3.1 and SPSS version-25 were used for data entry
and analysis respectively. Descriptive statistics were used and data were presented using
tables and figures. A binary & multiple logistic regression models were used to determine
the odds of enrollment for each predictor. The investigator obtained ethical clearance from
Addis Ababa University ethical review committee.
Results: The level of utilization of social marketing strategies for CBHI among households
was 75.6% (69% enrolled and 31% not enrolled) with level of utilization of house to house
sensitization (18.9%), local radio (11.1%), national radio (8.3%), and health facility based
sensitization (5.7%). The most motivator of the households to join CBHI was house to house
sensitization (37.81%). Multivariate Logistic regression revealed no significant association
between social marketing strategies and enrollment, but only house hold income (AOR =
0.023, 95% CI; 0.006–0.092, p<0.001) and family size (household with ≥ 4 members) (AOR
= 10.99, 95% CI; 3.19–37.83, p<0.001) were significant factors associated with enrollment.
Conclusion and recommendations: In this study, the overall level of utilization of existing
social marketing strategies was high but not significantly associated with households CBHI
enrollment. Family size and average monthly income of households were significant
determinants of enrollment and also most members were enrolled after being sick, indicating
that sensitization at the health facility by health service providers was the common social
marketing strategy. Thus, the study indicated evidence of adverse selections. The government
may need to look for options to make the CBHI scheme contribution based on the economic
status of households and compulsory.
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Keywords
Social marketing, Health insurance