3.1. Socio-demographic characteristics of study participants
From 770 sampled households, 762 participated in the study which yielded a response rate of 98.9%.The mean age of the respondents was 43.27 years, ranging from 19-70 years with standard deviation of 11.9years.
Regarding educational status of respondents 459 (60.2%) had no formal education and 303(39.8%) had formal education. The annual income of the households as calculated by principal component analysis showed that in a category of Poor 306(41%), Medium 152(19%) and Rich 304(40%). The annual household income, as estimated from the amount earned from sales of coffee, khat, maize, and local products in one year time, was 5000 ETB ranging between 900–15000ETB.(Tab.1)
Table 1: Socio-demographic characteristic of the study participants on community based health insurance enrollment and associated factors, in Sidama region Ethiopia 2020(n =762)
Variables
|
Categories
|
Frequency (%)
|
Age of Respondents
|
<30
|
136(17.8)
|
|
31-59
|
527(69.2)
|
|
>= 60 Years
|
99(13.0)
|
Sex
|
Male
|
544(71.4)
|
|
Female
|
218(28.6)
|
Marital status
|
Married
|
710(93.2)
|
|
Divorced
|
15(2)
|
|
Widowed
|
35(4.6)
|
|
Separated
|
2(0.2)
|
Religion
|
Orthodox
|
80(10.5)
|
|
Muslim
|
44(5.8)
|
|
Protestant
|
628(82.4)
|
|
Others
|
10(1.3)
|
Ethnicity
|
Sidama
|
695(91.2)
|
|
Amhara
|
36(4.7)
|
|
Gurage
|
26(3.4)
|
|
Others
|
5(0.7)
|
Occupation
|
Agriculture
|
539(70.7)
|
|
Merchant
|
181(23.8)
|
|
Government employ
|
22(2.9)
|
|
Laborers
|
19(2.5)
|
|
Others
|
1(0.1)
|
Family size
|
<3
|
156 (20.4)
|
|
3-6
|
487(64.0)
|
|
>=6
|
119(15.6)
|
Educational status
|
Unable to read & write
|
221(29)
|
|
Able to read &write
|
238(31.2)
|
|
Primary education
|
167(21.9)
|
|
Secondary & above education
|
136(17.8)
|
Wealth index of households
|
|
|
|
Poor
|
306(41%)
|
|
Medium
|
152(19%)
|
|
Rich
|
304(40%)
|
Annual income of households
|
>1200
|
94(12.3)
|
|
1200-3600
|
150(19.7)
|
|
3600-7200
|
308(40.4)
|
|
>7200
|
210(27.6)
|
3.2 Community based health insurance enrollment and renewal status
Regarding enrollment rate, about 154(20.2%) participants were member in Community Based Health insurance. Among one hundred fifty four enrolled in CBHI, only 94 participant were renewed their membership card prior to study period (fig.1).
3.3. Factors associated with community Based Health Insurance enrollment
Age of respondents had showed significant association; accordingly household heads falling in age group of 31-59 years and above 60 years were 2.62 and 2.87 times more likely enrolled in CBHI than age group less than 30 years with (AOR :2.62, 95% CI: 1.48-4.66) and(AOR: 2.87, 95% CI :1.23-6.74) respectively. Household family size was a significant determinant of enrollment in the scheme. Households who had family size 3-6 were 4.23 times more likely enroll in CBHI than fever family size (AOR : 4.23, 95%CI : 2.45-7.37).
Education of respondents was showed significant association in multivariate analyses. Respondents who had no formal education were 1.66 times more likely enrolled in CBHI than those had formal education (AOR :1.66, 95% CI:1.02-2.72)(tab.2a).
Knowledge of respondents towards community-based health insurance was showed significant association. Those knows the services covered under community based health insurance were 3.53 times more likely enrolled in CBHI than those had poor knowledge (AOR: 3.53 ; 95% CI:1.21-10.27). Information towards CBHI was also showed significant association. Those had ever heard about community based health insurance were 0.09times less likely enrolled in CBHI than those had no information (COR: 0.09 ; 95% CI:0.02 - 0.39) but it was not found significant in multivariate analysis(tab.2b).
In our study, premium (regular contribution) affordability had showed significant association both in bivariate and multivariate analysis. Those thought premium payment is not affordable were 72%less likely enrolled in community based health insurance (AOR: 0.28, 95% CI: 0.15-0.54) than the opposite. (tab. 2b)
Households having chronic illness had showed significant association both in bivariate and multivariate analyses with ((COR :0.06, 95% CI: 0.04-0.09) and (AOR : 0.26, 95% CI: 0.10-0.61).Those households had no chronic illness in the member were 74% less likely enrolled in community based health insurance. Similarly, households with no history of any illness in the past three months also had showed significant association (AOR: 0.08, 95% CI: 0.03-0.17)). Those encountered no any illness in the past three months were 0.08 times less likely enrolled in CBHI than counterparts. (tab.2b)
Regarding perceived quality of health care services, our study had showed that those perceived the quality of services was medium, were 48% less likely enrolled in CBHI than those perceived the quality of services was good in the health facility (AOR :0.52, 95% CI : 0.25-0.87). (tab.2b)
Table2a: Factors which are associated with community based health insurance enrollment in Sidama region Ethiopia, 2020 (n=762)
Variables(n=762)
|
CBHI enrollment
|
COR(95%CI)
|
AOR (95%CI)
|
P- value
|
Yes (%)
|
No (%)
|
|
|
|
Age of respondents
|
|
|
|
|
|
<30
|
42(30.9)
|
94(61.1)
|
|
|
|
31-59
|
94(17.8)
|
433(82.2)
|
2.06(1.34-3.15)
|
2.62(1.48-4.66)
|
0. 01*
|
>=60 years
|
18(18.2)
|
81(81.8)
|
2.01(1.07-3.76)
|
2.87(1.23-6.74)
|
0.02*
|
Sex of respondents
|
|
|
|
|
|
Female
|
38(17.4)
|
180(82.6)
|
1.28(0.86-1.93)
|
0.84(0.48-1.48)
|
0.54
|
Male
|
116(21.3)
|
428(78.7)
|
|
|
|
Family size
|
|
|
|
|
|
<3
|
57(36.5)
|
99(63.5)
|
|
|
|
3-6
|
59(12.1)
|
428(87.9)
|
4.17(2.73-6.39)
|
4.23(2.45-7.37)
|
0.00*
|
>=6
|
38(31.9)
|
81(68.1)
|
1.23(0.74-2.03)
|
1.41(0.66-2.98)
|
0.38
|
Educational status
|
|
|
|
|
|
No formal education
|
80(17.4)
|
379(82.6)
|
1.53 (1.07-2.19)
|
1.66 (1.02-2.72)
|
0.04*
|
Had formal education
|
74(24.4)
|
229(75.6))
|
|
|
|
Marital status
|
|
|
|
|
|
Married
|
146(20.5)
|
566(79.5)
|
|
|
|
Divorced
|
2(13.3)
|
13(86.7)
|
1.68(0.37-7.5)
|
|
NS
|
Widowed
|
6(17.1)
|
29(82.9)
|
1.25(0.51-3.06)
|
|
NS
|
Annual income
|
|
|
|
|
|
<1200
|
15(16.0)
|
79(84.0)
|
1.32(0.69-2.52)
|
|
NS
|
1200-3600
|
32(21.3)
|
118(78.7)
|
0.92(0.55-1.55)
|
|
NS
|
3600-7200
|
65(21.1)
|
243(78.9)
|
0.94(0.61-1.44)
|
|
NS
|
>7200
|
42(20.0)
|
168(80.0)
|
|
|
|
Wealth index
|
|
|
|
|
|
Poor
|
62(20.3)
|
244(79.7)
|
1.02(0.69-1.51)
|
|
NS
|
Medium
|
29(19.1)
|
123(80.9)
|
1.10(0.68-1.80)
|
|
NS
|
Rich
|
63(20.7)
|
241(79.3)
|
|
|
|
Occupation of the respondents
|
|
|
|
|
|
Farmer
|
100(18.6)
|
439(81.4)
|
0.73(0.30-1.78)
|
0.50(0.14-1.84)
|
0.29
|
Merchant
|
48(26.5)
|
133(73.5)
|
0.46(0.18-1.16)
|
0.40(0.11-1.47)
|
0.17
|
Laborer & others
|
6(14.3)
|
36(85.7)
|
|
|
|
Distance to facility
|
|
|
|
|
|
<5 KM
|
101(21.8)
|
363(78.1)
|
0.78(0.54-1.13)
|
0.66(0.39-1.12)
|
0.13
|
>=5KM
|
53(17.8)
|
245(82.2)
|
|
|
|
- * = P < 0.05
- NS = Not found significant in bivariate analysis (P >0.25)
Table 2b: Factors which are associated with community based health insurance enrollment in Sidama region Ethiopia, 2020 (n=762)
Variables(n=762)
|
CBHI enrollment
|
COR(95%CI)
|
AOR (95%CI)
|
P- value
|
Yes (%)
|
No (%)
|
|
|
|
Ever heard about CBHI program
|
|
|
|
|
|
Yes
|
129(22.1)
|
454(77.9)
|
1.75(1.09-2.79)*
|
1.48(0.74-2.97)
|
0.27
|
No
|
25(13.9)
|
154(86.1)
|
|
|
|
Do you know services covered under CBHI
|
|
|
|
|
|
Yes
|
147(22.9)
|
494(77.1)
|
4.84(2.21 -10.63)
|
3.53(1.21-10.27)*
|
0.02*
|
No
|
7(5.8)
|
114(94.2)
|
|
|
|
Premium payment time convenient
|
|
|
|
|
|
Yes
|
71(35.3)
|
130(64.7)
|
|
|
|
No
|
83(14.8)
|
478(85.2)
|
0.32(0.22-0.46)*
|
0.58(0.32-1.06)
|
0.07
|
Registration fee affordable
|
|
|
|
|
|
Agree
|
141(24.7)
|
431(75.3)
|
|
|
|
Disagree
|
13(6.8)
|
177(93.2)
|
0.23(0.12-0.41)*
|
0.67(0.28-1.56)
|
0.35
|
Premium affordable
|
|
|
|
|
|
Agree
|
112(32.7)
|
230(67.3)
|
|
|
|
Disagree
|
42(10.0)
|
378(90.0)
|
0.23(0.16-0.34)*
|
0.28(0.15-0.54)*
|
0.00*
|
Currently have any loans?
|
|
|
|
|
|
Yes
|
37(19.0)
|
158(81.0)
|
0.90(0.59-1.36)
|
1.10 (0.61-2.00)
|
0.74
|
No
|
117(20.6)
|
450(79.4)
|
|
|
|
Persons with chronic illness/disability in the HHs
|
|
|
|
|
|
Yes
|
85(68.0)
|
40(32)
|
|
|
|
No
|
69(10.8)
|
568(89.2)
|
0.06(0.04-0.09)*
|
0.26(0.11-0.61)*
|
0.00*
|
Any illness encountered in last 3 months
|
|
|
|
|
|
Yes
|
102(64.6)
|
56(35.4)
|
|
|
|
No
|
52(8.6)
|
552(91.4)
|
0.05(0.03-0.08)*
|
0.08(0.03-0.17)
|
0.00*
|
Perceived quality of Health care services
|
|
|
|
|
|
Poor
|
47(14.7)
|
272(85.3)
|
1.18(0.68-2.05)*
|
1.10(0.0.51-2.40)
|
0.81
|
Medium
|
85(27.2)
|
228(72.8)
|
0.55(0.32-0.92)*
|
0.52(0.25-0.87)
|
0.01*
|
Good
|
22(16.9)
|
108(83.1)
|
|
|
|
Level of satisfaction with health care services & costs
|
|
|
|
|
|
Very satisfied
|
19(26.4)
|
53(73.6)
|
0.40(0.22-0.74)*
|
0.83(0.36-1.89)
|
0.65
|
Average
|
92(26.4)
|
256(73.6)
|
0.40(0.27-0.59)*
|
0.64(0.37-1.09)
|
0.09
|
Not satisfied
|
43(12.6)
|
299(87.4)
|
|
|
|
* = P < 0.05