Online Program

Knowledge, Attitudes and Practices Regarding Community-Based Health Insurance in Dembecha Town, Ethiopia, 2014: A Cross-Sectional Design

Tuesday, November 3, 2015

Xiuzhe (Ally) Mai, MPH, Public Health Program, Touro University, California, Vallejo, CA, Vallejo, CA
Dube Jara, MPH, Department of Public Health, College of Medicine and Health Science, Debre Markos University, Ethiopia, Debre Markos, Ethiopia
Sahai Burrowes, PHD, MALD, Public Health Program, Touro University, California, Vallejo, CA, Vallejo, CA
Background: This study investigates associations between the utilization of a community-based health insurance (CBHI) program in Ethiopia and community member’s knowledge of, and attitudes towards the program. Information on these potential relationships, which is largely lacking in current scholarship, is crucial for the planned nation-wide scale-up of the CBHI program.  

Methods: This cross-sectional study uses a survey of 328 randomly selected households in Dembecha, a peri-urban town in the Amhara region. Data were analyzed using multivariate linear and logistic regression models.

Findings: Although the majority of residents (67%) had information about CBHI, mostly from health institutions (48%). Most (62%) did not know that there was a CBHI program in Dembecha. Moreover, over half of respondents had incorrect knowledge about policies on monthly premiums and fees. Higher income and education and being a young adult were positively associated with program knowledge (p<0.01).

Attitudes about CBHI were generally positive. Low-income individuals, high health spenders, civil servants, and those knowledgeable about the program were all more likely to view CBHI favorably than their counterparts (p<0.01).

The vast majority (84%) of respondents had not enrolled in CBHI; mainly because they lacked information about it (70% of non-enrollees). Health service utilization was modest for CBHI enrollees. The main reason for non-utilization was lack of coverage or poor availability of the needed health service. High CBHI knowledge and having experienced a prior death or health problem in the family were positively related to CBHI uptake (p<0.01).

These findings suggest that more intensive CBHI education on payments is needed and that services covered should be reviewed.

Learning Areas:

Assessment of individual and community needs for health education
Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the association between health literacy and utilization of community-based health insurance (CBHI) in Ethiopia; Analyze the impact that socio-demographic characteristics have on the knowledge, attitudes, and practices with respect to CBHI; Inform education campaigns and program development for the planned national scale up of Ethiopia’s pilot CBHI programs.

Keyword(s): Health Insurance, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am one of the principal investigators for this project and have over 10 years of experience designing, managing, and assessing HIV/AIDS and reproductive health programs in sub-Saharan Africa. I currently coordinate Ethiopian global health field study research projects for MPH students at Touro University, where I am an assistant professor. My research involves studying the sub-national financing and national policy-making processes of global health interventions in sub-Saharan Africa.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4376.0: Poster Session 7