The Advantages and Challenges of Community-based Health Insurance (CBHI) as a Social Protection Scheme in Promoting Universal Health Coverage: The Case of Tocha District, Dawuro Zone

Abstract

The general objective of this research was to examine the advantages and challenges of CBHI as a social protection scheme in promoting universal health coverage. Theories used to guide this research were Anderson’s model of healthcare utilization and Woolcock’s Social capital framework. This research relied on pragmatist paradigm. Cross-sectional research design was used to guide the whole research process. Mixed research approach was employed to generate valid and reliable findings. Household survey, key-informant interview, in-depth interview, focus group discussion, observation and document analysis were used to collect reliable data on research issue. Quantitative data was analyzed using descriptive and inferential statistical tools. SPSS version 23 was used to process numerical data and qualitative data was analyzed by employing thematic analysis. The findings of this research revealed that the advantages of CBHI from service providers’ perspectives were increased access to health care, enhanced health seeking behavior, increased health care utilization, improved health status of insured households, promoted health equity, increased availability of financial resources in contracted health facilities and improvement of the quality of health services. Advantages of CBHI from community’s perspectives were increased access to health services, enhanced health seeking behavior, increased health care utilization, improved health status of CBHI members, reduced costs of health services, relief from concern about unexpected future health costs and reduction of the exposure to catestrophic and impoverishing health expenditure. CBHI promoted the involvement of indigent households and thereby their utilization of health services. However, there are challenges that hinder the impact of CBHI in ensuring UHC. These include lower proportion of insured population, deficiency in quality of health services, small-scale design (lack of large risk pools), financial insecurity, and inadequate enrollment of indigent households in the scheme. To conclude, CBHI is pragmatic and highly essential initiative to progressively achieve universal health coverage because it increased access to health care, promoted health equity and improved the quality of health services in the study area. To improve the performance of CBHI, concerned bodies should design mechanisms that increase the community enrollment, participation and solve problems associated with health service provision.