Perceived Quality of Healthcare and Availability of Supplies Determine Household-Level Willingness to Join a Community-Based Health Insurance Scheme in Amhara Region, Ethiopia

Asmamaw Atnafu,¹ Amare Tariku<sup>2

1</sup>Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; ²Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Correspondence: Asmamaw Atnafu
University of Gondar, PO Box 196, Gondar, Ethiopia
Tel +251-918776945
Email asme2002@gmail.com

Purpose: The Ethiopian health system has been challenged by a shortage of funds and is heavily reliant on foreign donation. However, voluntary community-based health insurance (CBHI) has been implemented to reach and cover the very large agricultural sector since 2010. Thus, the level of acceptability of the scheme needs to be regularly assessed through households’ willingness to join before the nationwide rollout of the scheme. This study was intended to assess the level of willingness to join in community-based health insurance and associated factors in northwest Ethiopia.
Patients and Methods: Using a pretested structured questionnaire, a cross-sectional community-based study was conducted in 2017 in Amhara Region, northwest Ethiopia. Using a multi-stage sampling method, from 15 clusters in which CBHI was implemented, 1,179 households without CBHI membership were included as a sample for the study. Bivariable and multivariable logistic regression was fitted to assess the association between predictor variables and the outcome of interest.
Results: Out of the total (1,179) participants, 60.5% (713) were willing to join the scheme. Households’ occupation (AOR=2.26; 95% CI:=1.12– 5.07), perceived good (AOR=2.21; 95% CI:=1.53− 3.21), and medium (AOR=1.44; 95% CI=1.22– 2.0) healthcare quality and richer wealth status (AOR=1.72; 95% CI=1.08– 2.73) were associated with higher odds of willingness to join the scheme.
Conclusion: As The study revealed that level of willingness to join is lower compared to other studies. Therefore, social protection activities for the low-income population and enhancement of the capacity of health facilities are crucial.

Keywords: willingness to join, community-based health insurance, developing country, Ethiopia