Enrollment status of communit-based healthinsurance and Associated factors among households in pawi woreda, metekel zone Benishangul gumz region, northwest ethiopia

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