Willingness to Enroll For Community-Based Health Insurance and Associated Factors among Household Heads in the Rural Community of Fogera District, Northwest Ethiopia

Introduction: Globally, 150 million people suffered from financial catastrophic shock each year, and 100 million are pushed into poverty because of direct payments for health services. Community-based health insurance schemes are becoming increasingly recognized as a tool to finance health care in developing countries; however, it is still early stage of implementation in Ethiopia. Therefore, this study was conducted to assess the willingness to enroll for community-based health insurance and associated factors among household heads in the rural community of Fogera district, North West Ethiopia.

Methods: A community-based cross-sectional study was conducted among 528 households in 2014. A multistage sampling was used to select the study participants. Pre-tested structured interviewer-administered questionnaire was used to collect the data. The data were analysed using SPSS computer software package version 20.A multivariable logistic regression analysis was used to investigate factors associated with willingness to enroll for community-based health insurance. Adjusted Odds Ratios (AOR) with the corresponding 95% Confidence Interval (CI) was used to show the strength of associations, and variables with P-values of <0.05 were considered statistically significant.

Result: The finding revealed the 80%, 95%CI:(75.7%-83.7%) of respondents expressed willingness to enroll in the Community-based health insurance system. The main reason for those who were not willing to enroll in the scheme was that they preferred out of pocket payment to the scheme. According to the multivariable logistic regression analysis, advanced age (>45 years) [AOR: 0.52, 95%CI (0.31, 0.89)], schooling experience [AOR: 2.14, 95%CI (1.187, 3.86)]and having two and above under-5years children [AOR: 2.22, 95%CI (1.06, 4.86)] were significantly associated with community based health insurance enrollment.

Conclusion and recommendation: The willingness to enroll for the Community-based health insurance scheme was encouraging to achieving universal health coverage through financial risk protection. Hence, mobilizing and educating the community about the drawback of out of pocket payment and specify the number of premiums for community-based health insurance based on household size should be continued.