Abstract:
Background: Community-based health insurance is a promising concept towards financial
hardships associated with paying for health services. Ethiopia is a low-income country with more
health spending out-of-pocket payments by households and recently introduced the community-
based health insurance scheme. However, its status of enrollment and associated factors are not
well studied in the Benishangul Gumuz region of Ethiopia in general and in Pawi woreda in
particular.
Objective: To assess the enrollment status of community-based health insurance and associated
factors in Pawi Woreda, Metekel Zone Benishangul Gumuz Region, Northwest, Ethiopia;2021.
Methods: A community-based cross-sectional study was conducted among a randomly selected
sample of 435 households in Pawi Woredafrom June 23 to August 23, 2021. Data were collected
by using an interviewer-administered structured questionnaire and analyzed using SPSS version
25. Descriptive statistics were computed to present the data and describe the study participants.
Then bivariate and multivariate logistic regression analysis was done to identify associations
between dependent and independent variables at P-value <0.05.
Result: The overall enrollment status of the households in community-based health insurance
was found to be 65. 7 %.Merchants (AOR= 0.47; 95%CI: 0.28, 0. 79), and daily laborers
(AOR=0.42; 95%CI: 0.20, 0. 89) were less likely to be enrolled in to the CBHI as compared to
farmers. Those in the highest wealth tertiles (rich) were about 40% lower to be enrolled in to the
CBHI as compared to the lowest wealth tertiles (poor) (AOR=0.68; 95%CI: 0.39, 0.97).Those
who had good knowledge (AOR=4.33; 95%CI: 2. 72, 6. 89) and favorable attitude (AOR=3.10;
95%CI: 1.91, 5.36)about CBHI were more likely to be enrolled as compared to those having
poor knowledge and unfavorable attitude, respectively. Existence of chronic illness in the
increased the likelihood of CBHI enrolment by nearly three times (AOR=2. 64; 95%CI: 1.23, 5.
68).
Conclusion: The overall enrollment status of the households in community-based health
insurance (65. 7%) is better than the statusesof studies in the otherparts of the country; but, still
low to reach every household in the study area.Occupation, wealth index, knowledge, attitude
and existence of chronic illness in the family were the factors affecting enrollment of the
households in community-based health insurance in the study area. Hence, improving the
knowledge and attitude of the community about the benefits of the CBHI is an urge
