Patterns of enrollment to community-based health insurance and the situations influencing utilization of the services in Southern Ethiopia: a qualitative study

Abstract

A community-based health insurance (CBHI) scheme was proposed by the World Health Organization, hoping that it would provide financial protection by reducing out-of-pocket expenditure and enhancing health-seeking behavior. The utilization of CBHI, however, is influenced by a variety of factors. Because these factors differ according to differing socio-economic contexts and understanding them in a specific context would help to improve the use of the scheme, we examined the situations influencing the utilization of CBHI in Sodo Zuria woreda, southern Ethiopia. Using a phenomenological approach, the study relied on qualitative data from 21 in-depth interviews and 4 FGDs with beneficiaries, as well as 12 key informant interviews with health professionals and kebele leaders. Audio records were first transcribed verbatim, translated to English, and transported to Atlas.ti 7 software. Transcriptions, along with field notes and memos, were coded, and subsequently, themes and sub-themes were identified. Accordingly, the study revealed that low levels of educational attainment, lack of program awareness, lack of pharmaceuticals and medical supplies, lack of adequate healthcare professionals, distance from home, and administrative complexities undermine the utilization of community-based health insurance. The situation exposes beneficiaries to out-of-pocket medical expenses, thereby negating the goal of the CBHI program. As a result, the Ministry of Health, in conjunction with other governmental and non-governmental bodies, should ensure that enough pharmaceuticals and medical supplies are provided. In addition, efforts should be made to make sure that there are enough health workers and that a convenient working procedure is established in health centers.

Keywords:

• Community-based health insurance
• utilization
• qualitative study
• Ethiopia
• healthcare system

REVIEWING EDITOR:

• Joe Thomas, Institute of Health and Management, Australia

SUBJECTS:

• Health & Society
• Public Health Policy and Practice
• Social Work and Social Policy

Acknowledgements

We wish to convey our sincere gratitude to the study participants for their time and willingness to share their perspectives. Additionally, we extend our heartfelt appreciation to the reviewers who generously dedicated their time to meticulously review the manuscript and provide invaluable suggestions for its improvement.

Disclosure statement

The authors report there are no competing interests to declare.

Limitations of the study

The present research has several limitations. Firstly, the study primarily gathered information from CBHI members in the community. However, it would have been beneficial to include non-CBHI community members and conduct a comparison between these two groups. This approach would have aided in understanding why households aren’t joining the program and in identifying overall differences in attitudes and perceptions toward the CBHI program. Secondly, an examination of households in various woredas (districts) and socio-cultural settings would have provided more comprehensive information about service uptake and determinants in different contexts. Finally, the study would have greatly benefited from the combination of qualitative and quantitative methods.

Data availability statement

The data used to support the analysis for this study can be obtained from the corresponding author upon reasonable request.

Notes

1 Kebele is the lowest administrative unit of the government in Ethiopia.

2 Since recent times, motorcycle has become the most commonly used mode of transportation in most rural and some urban areas in Ethiopia.

Additional information

Notes on contributors

Getahun Siraw

Getahun Siraw is a senior lecturer of sociology at Dilla University, Ethiopia. He is dedicated to teaching and mentoring students while also conducting cutting edge sociological researches. His research interests are in important societal issues, with public health, gender, marginalization and IDPs attracting his attention and has published several research findings.

Bewunetu Zewude

Bewunetu Zewude studied of sociology at Addis Ababa University, Ethiopia. He has rich experience in teaching, advising and examining undergraduate and postgraduate students of higher education institutions in Ethiopia. In addition to consulting social affairs, Bewunetu has always been undertaking studies on the health and welbeing of children, youth women and other vulnerable groups. He has also published several articles in peer reviewed journals.

Muluken Meshesha

Muluken Meshesha is currently working as a community research officer in Wolaita zonal administration. He received his MA degree in sociology from Wolaita Sodo University.