mplementation evaluation of Community Based Health Insurance in Limu Kossa District, Jimma Zone, South West Ethiopia

Abstract

Background: Community based health insurance is a method of financial protection that protect out-of-pocket health care expenditure and increase access of health cares for rural population. High income countries achieved universal coverage by using different method of social protection but in low and middle income countries, out-of-pocket payments of health care are remain high, this created constraints to utilizing essential health services. Many African countries still now face challenges in initiating, sustaining, or scaling-up community based health insurance. Limu kossa district is one of the 13 districts in Ethiopia that have been implementing this insurance as pilot program since 2012. The objective: The objective of this study was to evaluate the level of implementation of CBHI in Limu Kossa district, southwest Ethiopia. Method: Implementation evaluation of community based health insurance was conducted by using mixed case study design in Limu Kossa district on health institutions. Three evaluation dimension: availability, compliance and acceptability dimension with 43 indicators were used. All health institutions (six health centers and one district hospital) those have signed contractual agreements with the CBHI administration to implement community based health insurance were included in the study. Two hundred thirty one (231) members and 37 key informants of scheme were interviewed, Documents of community based health insurance were reviewed and inventory observation was conducted. The quantitative data were analyzed by descriptive statistic while qualitative data were analyzed thematically. Results: The study found that the overall availability resource dimension implementation status was 60.43% which partial implemented according judgment parameter. From total health institutions 2(27%) of them had trained health workers on the scheme and 4 (57%) of them had essential tracer drugs and laboratory services. The overall implementation status of compliance dimension was 55% which were poor implemented according to judgment parameter. Community mobilization session conducted in the year was 1(25%). From total patients visited health institutions, 82% were insured patients. The result from showed that the scheme enrolment reach 49% in2015,renewed rate were 90%,drop rate were 10% and 26.24% were growth rate. The mean members’ satisfaction was 3.94 which shows almost insured patients were satisfied toward the scheme. Study from qualitative data also shows that there were low community awareness to toward the schemes, shortage of medical equipment and drugs in health institutions and inactive health care finance in most health institutions. Conclusion: Generally the overall the level of implementation of CBHI were in the Limu Kossa district was found to be partially implemented. Therefore the stakeholders of the scheme have to increase community awareness, fulfill essential resource for health institutions and strength health care finance in health institutions.