Abstract:
Background: In Ethiopia out of pocket health expenditure is high risking to
impoverishment, inequitable access and utilisation of health care to curb this government
has developed a health insurance policy to improve financial access, quality and health
care coverage. To solve these problems, to successfully implement the community based
health insurance in the district and nearest districts there exists a thin layer of evidence.
Nevertheless, evidence on magnitudes of the households actively utilizing health
insurance and factors that drive households to utilize the program is unknown that makes
sustainability and effectiveness of the program in question.
Objective: To assess community based health insurance utilization and associated factors
among informal workers in Gida Ayana district, East Wollega Zone, West Ethiopia.
Methods: A community based cross sectional study design was used among randomly
selected 644 households. Binary logistic regression analysis was used to compute crude
odds ratio with its 95% confidence interval to test the associations between dependent and
independent variables. Then variables found to have P<0.25 in the bi-variable analysis
was taken as candidate for multivariable analysis. A P-value of 0.05 with a confidence
interval of 95% was used to declare level of statistical significance.
Results: The prevalence of community based health insurance utilization was 27.5% [(95%
CI:[ 23.8, 31.2)].Covariates like: Relatively older ages [(AOR: 3.26; 95% CI:[1.80, 5.90)],
formal education [(AOR: 5.8; 95%CI:[3.38, 10.00)], farmers [(AOR: 2.9; 95% CI:[1.40,
6.00)], rich wealth index [(AOR: 2.40; 95% CI:[ 1.40, 4.26)] and disagree on affordability of
premium [(AOR: 0.50; 95% CI: [(0.27,0.97)], good knowledge on CBHI [(AOR:2.30 :95%
CI:[1.40,3.85)], self-assessed health status as poor [(AOR:4.2;95% CI:[2.20, 8.00)] and
neutral on trustworthiness of management officials [(AOR: 0.43; 95% CI:[0.20, 0.76)] had
statistically significant association with community based health insurance utilization.
Conclusion: The prevalence of community based health insurance utilization in this study
area was low. This study pinpointed the need to disseminate information and discuss with
community on the issues related to principles of community based health insurance, the
benefit packages, the premium and efforts should be devoted to meet expectation of the
community regarding the quality of healthcare by the District health office, insurance
officials and health professionals to enhance the utilization.
