Determinants of enrolment for community-based health insurance in Somali region of Ethiopia

Background: Community-based health insurance (CBHI) is a type of health insurance programme that provides financial protection against the cost of illnesses and improves access to healthcare services for communities in the informal sector. Aim: The aim was to assess the determinants of enrolment fo...

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Main Authors: Abdifatah Elmi, Olusola Oladeji, Ahmed Tahir
Format: Article
Language:English
Published: AOSIS 2025-02-01
Series:Journal of Public Health in Africa
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Online Access:https://publichealthinafrica.org/index.php/jphia/article/view/726
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author Abdifatah Elmi
Olusola Oladeji
Ahmed Tahir
author_facet Abdifatah Elmi
Olusola Oladeji
Ahmed Tahir
author_sort Abdifatah Elmi
collection DOAJ
description Background: Community-based health insurance (CBHI) is a type of health insurance programme that provides financial protection against the cost of illnesses and improves access to healthcare services for communities in the informal sector. Aim: The aim was to assess the determinants of enrolment for CBHI in Aw-barre district – an agro-pastoral setting in the Somali region, Ethiopia. Setting: Ethiopia launched the CBHI scheme in 2011 as part of the revised healthcare financing strategy to realise universal health coverage. It was then scaled up in the rural part of the country in 2013, except the pastoralist regions including the Somali region which started as late as 2020. Methods: A community-based, unmatched case-control study was conducted using a concurrent nested approach between March 2021 and April 2021, among 214 participants (54 enrolled and 160 non-enrolled). Quantitative data were analysed using SPSS version 20, and thematic analysis was performed for the qualitative data. Results: Awareness of the CBHI scheme adjusted odds ratio (AOR) = 9.67 (1.26, 74.53), household income AOR = 3.56 (1.03, 12.30) and being a member of community-based solidarity groups AOR = 2.48 (1.17, 5.26) were the determinants for CBHI enrolment and were reaffirmed by the qualitative findings. Conclusion: Increasing community awareness of the scheme via various platforms is essential. Leveraging community-based solidarity associations, and social protection platforms would help increase enrolment. Contribution: Given the distinct sociodemographic, economic and geographic peculiarities of agro-pastoralists, the CBHI parameters and implementation strategies must be tailored to the setting before scaling it up.
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spelling doaj-art-af78d342647a475bbc32e65fbe447aae2025-08-20T02:14:03ZengAOSISJournal of Public Health in Africa2038-99222038-99302025-02-01161e1e710.4102/jphia.v16i1.726802Determinants of enrolment for community-based health insurance in Somali region of EthiopiaAbdifatah Elmi0Olusola Oladeji1Ahmed Tahir2Health Section, UNICEF Somali Field Office, JigjigaHealth Section, UNICEF Somali Field Office, JigjigaSchool of Public Health, Jigjiga UniversityBackground: Community-based health insurance (CBHI) is a type of health insurance programme that provides financial protection against the cost of illnesses and improves access to healthcare services for communities in the informal sector. Aim: The aim was to assess the determinants of enrolment for CBHI in Aw-barre district – an agro-pastoral setting in the Somali region, Ethiopia. Setting: Ethiopia launched the CBHI scheme in 2011 as part of the revised healthcare financing strategy to realise universal health coverage. It was then scaled up in the rural part of the country in 2013, except the pastoralist regions including the Somali region which started as late as 2020. Methods: A community-based, unmatched case-control study was conducted using a concurrent nested approach between March 2021 and April 2021, among 214 participants (54 enrolled and 160 non-enrolled). Quantitative data were analysed using SPSS version 20, and thematic analysis was performed for the qualitative data. Results: Awareness of the CBHI scheme adjusted odds ratio (AOR) = 9.67 (1.26, 74.53), household income AOR = 3.56 (1.03, 12.30) and being a member of community-based solidarity groups AOR = 2.48 (1.17, 5.26) were the determinants for CBHI enrolment and were reaffirmed by the qualitative findings. Conclusion: Increasing community awareness of the scheme via various platforms is essential. Leveraging community-based solidarity associations, and social protection platforms would help increase enrolment. Contribution: Given the distinct sociodemographic, economic and geographic peculiarities of agro-pastoralists, the CBHI parameters and implementation strategies must be tailored to the setting before scaling it up.https://publichealthinafrica.org/index.php/jphia/article/view/726health insurancedeterminantsenrolmentagro-pastoralsomali regionethiopia
spellingShingle Abdifatah Elmi
Olusola Oladeji
Ahmed Tahir
Determinants of enrolment for community-based health insurance in Somali region of Ethiopia
Journal of Public Health in Africa
health insurance
determinants
enrolment
agro-pastoral
somali region
ethiopia
title Determinants of enrolment for community-based health insurance in Somali region of Ethiopia
title_full Determinants of enrolment for community-based health insurance in Somali region of Ethiopia
title_fullStr Determinants of enrolment for community-based health insurance in Somali region of Ethiopia
title_full_unstemmed Determinants of enrolment for community-based health insurance in Somali region of Ethiopia
title_short Determinants of enrolment for community-based health insurance in Somali region of Ethiopia
title_sort determinants of enrolment for community based health insurance in somali region of ethiopia
topic health insurance
determinants
enrolment
agro-pastoral
somali region
ethiopia
url https://publichealthinafrica.org/index.php/jphia/article/view/726
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AT olusolaoladeji determinantsofenrolmentforcommunitybasedhealthinsuranceinsomaliregionofethiopia
AT ahmedtahir determinantsofenrolmentforcommunitybasedhealthinsuranceinsomaliregionofethiopia