Abstract:
Background: Community-based health insurance emerged with exciting ideas in accessing reliable
health care services for low and middle-income countries, with a goal of additional fund mobilization
to the health sector and creating risk-pooling mechanisms for the poorest. However, despite increasing
efforts, recent empirical evidence revealed enrolment has remained low.
Objective: The main objective of the study was to identify factors determining community-based
health insurance enrolment schemes in Nekemte Town, East Wollega zone, Oromia region, western
Ethiopia, 2023
Methods: A community-based un-matched case-control study was carried out in Nekemte town on
488 households who were randomly selected. The study population comprised enrolled (case group;
n=244) and non-enrolled (control group; n=244) to Community Based Health Insurance Scheme. Data
were collected by interview using a structured and pre-tested questionnaire. Epi Data version 4.6 was
used for data entry and SPSS version 25 was used for data analysis. Both bivariable and multivariable
logistic regression analyses were used. In a multivariable model, the adjusted odds ratio together with
the corresponding 95% confidence interval was used to assess the strength of the association between
the dependent variable and covariates. Statistical significance was declared at p-values<0.05.
Results: A total of 488 Households (cases =244 and controls = 244) participated in the study with a
response rate of 100%. Having awareness of Community Based Health Insurance (AOR=7.92,
95%CI=3.55,17.65), affordable/low cost of enrolment (AOR=9.0, 95%CI=3.24,25.00), medium
affordable/medium cost (AOR=4.0, 95%CI=1.567,10.25), trustworthiness of CBHI Scheme
(AOR=5.0, 95% CI=2.08,15.09), and having good knowledge about Community Based Health
Insurance (AOR=3.36, 95% CI=1.14,9.94) were found to be determinants of Community Based
Health Insurance enrolment.
Conclusions and Recommendations: Having awareness about CBHI, perceived affordability of
costs of Community Based Insurance, knowledge of Community health insurance, and trust in the
CBHI scheme were determinants of CHI enrolment. As well as improving trustworthiness by
strengthening the scheme management system and improving service quality, was recommended for
Community Based Insurance Scheme workers to increase household enrolment.
