A landmark study by Ethiopia’s Oromia Health Bureau and Addis Ababa University reveals that the country’s Community-Based Health Insurance (CBHI) program has significantly increased outpatient service utilization in Bacho Woreda, South West Shoa Zone. However, persistent gaps in drug availability, lengthy waiting times, and staff shortages are undermining efforts to improve perceived service quality and equitable access .
The study, conducted between late 2021 and 2022 among 386 households, found that CBHI members were over four times more likely to seek outpatient care than non-members. Over 80% of insured households reported visiting a health facility within six months of illness, compared to just 50% of uninsured households. Statistical analysis confirmed this association, highlighting CBHI’s role in reducing out-of-pocket financial barriers and encouraging timely treatment .
This aligns with broader trends: a 2022 PubMed study noted that CBHI members in Ethiopia had 0.36 more outpatient visits per capita annually than non-members in CBHI-implementing districts, while reducing catastrophic health expenditures by 28–43% . The program’s success in increasing utilization underscores its potential as a tool for financial risk protection, particularly for rural populations historically vulnerable to healthcare costs .
Despite its benefits, CBHI enrollment remains skewed across demographic groups:
Age: Households headed by individuals aged 51–86 were far more likely to enroll, while those led by 36–50-year-olds were 72% less likely.
Gender: Men were 70% more likely to enroll than women, reversing earlier pilot trends where female-headed households dominated participation.
Education: Illiterate or semi-literate households were 4–8 times more likely to join than those with tertiary education, likely reflecting differences in employment (e.g., informal vs. formal sectors) and perceived relevance of CBHI.
Geography: Rural households were more inclined to enroll, while urban residents were 56% less likely, possibly due to greater access to private healthcare options .
These disparities mirror findings from other regions. For example, a 2023 Frontiers study in Gida Ayana District found that while CBHI reduced wealth- and family-size-based disparities in healthcare utilization, urban residents and educated households remained underrepresented .
Households opting out cited lack of information (22%), perceived unaffordability of premiums (15%), mistrust of management, limited benefit packages, and dissatisfaction with public health services. Some even believed insured patients faced longer waiting times, deterring enrollment .
Financial viability: Low enrollment rates and high administrative costs leave many schemes financially strained, with some unable to pay health providers.
Service quality gaps: Shortages of drugs, medical supplies, and skilled staff, coupled with long reimbursement delays, erode trust in the program .
These challenges resonate with a 2024 BMC Health Services Research study in Gondar Zuria District, where 60% of CBHI members expressed dissatisfaction with waiting times and medication availability .
While CBHI has improved access, the study emphasizes the need to address service quality and management issues to ensure equitable participation. Recommendations include:
Transparent communication: Addressing misconceptions about waiting times and benefit packages through community engagement.
Capacity building: Investing in healthcare infrastructure, drug supply chains, and workforce training to improve service delivery .
The Ethiopian government has already taken steps, such as integrating CBHI with the Productive Safety Net Program (PSNP) to enroll food-insecure households . However, scaling such initiatives requires political will and sustained funding. A 2022 WHO report highlighted success stories, such as a woman named Misrak whose family’s healthcare costs were fully covered by CBHI after years of financial strain, underscoring the program’s life-changing potential when effectively implemented .
Related topics:
