Demographic and socio-economic characteristics of respondents
A total of 285 study participants responded for the interviews, making the response rate 96.3%. All in all, (90.9%) of the study participant households were willing to join the community-based health insurance scheme. Among study participants, (88.4%) and (11.6%) were male and female respectively. The age of the respondents has been classified with 4 age categories. The results show that, (10.9 % )of the respondents were in age category of 18-28, While(16.8%) them were from 50 and above 50 years and (34.1%)were from 40-49.The significant number of the respondent’s (38.2%%) was in the age category of 29-39. This implies that, the majority of the respondents were concentrated in the age category of adult and productive age. Regarding to place of the residence, majority of the respondents (81.1%) were rural and the rest (18.9%) were urban dweller. Concerning to religious affiliation of the study participants, (86.3%) and (13.7%) they were Orthodox and others.
It can be understood that, the majority study participants from marital status category was married (89%). Concerning the educational level (44.2%) of the respondents were illiterate, (29.8%) them were read and write educational status, while (26.8%) of them were primary school and above. As shows in Table 1, the occupational status of the respondents (60.7%) were engaged farming and (7.7%) were house wife. The 5.3 % of the respondents were government employee, while (12.3%) were working as a daily laborer and (14%) of them were merchants. The study result shows that (74.4%), (18.9%) and (6.7%) of the respondents have an average monthly income from 300-2000, 2001-4000 and 4001-9000 ETB within households respectively.
Table 1
Demographic and socio-economic characteristics of study participants in North Mecha Woreda, West Gojjam Zone, Amhara region Ethiopia
Variables
|
Frequency (N)
|
Percentage (%)
|
Sex
|
Male
|
252
|
88.4
|
Female
|
33
|
11.6
|
Age
|
18-28
|
31
|
10.9
|
29-39
|
109
|
38.2
|
40-49
|
97
|
34.1
|
50 and above 50
|
48
|
16.8
|
Place of residence
|
Rural
|
231
|
81.1
|
Urban
|
54
|
18.9
|
Religion
|
Orthodox
|
246
|
86.3
|
Others
|
39
|
13.7
|
Marital status
|
Single
|
15
|
5.3
|
Married
|
254
|
89
|
Widower/Widow
|
10
|
3.5
|
Divorced
|
6
|
3.1
|
Educational status of HH
|
Illiterate
|
126
|
44.2
|
Read and write
|
85
|
29.8
|
Primary school & above
|
74
|
268
|
Occupational status of HH
|
Farming
|
173
|
60.7
|
House wife
|
22
|
7.7
|
Government employee
|
15
|
5.3
|
Laborer
|
35
|
12.3
|
Merchants
|
40
|
14
|
Monthly average income of family
|
300-2000
|
212
|
74.4
|
2001-4000
|
54
|
18.9
|
4001-9000
|
19
|
6.7
|
Household size
|
1-3
|
136
|
47.7
|
4-6
|
118
|
41.4
|
7&above
|
31
|
10.9
|
Filed survey, 2020/21 |
The characteristics of respondents by the levels of WTJ, health status and health service utilization
Among study participants, 90.9% of households had joined a CBHI scheme. The majority of participants, (35.8%) of them were join before three years ago, while, (15.4%), (25.3%), and( 23.5%) of them were join ,before one year, two years and four years ago respectively. From 285 total study participates (93.3%) were reported that join in CBHI have advantages, while, the benefits were as follows, (86.8%) were reduce OOP expenditure,(8.3%) of them improve health status, (2.3%) were reduce the risk of severity and (2.6%) foster productivity.
Among participants who had WTJ, (89.8%) were also willing to pay for this proposed health insurance scheme. With regard to CBHI premium, (70.2%) of respondents reported that paying the proposed health insurance cost was affordable. Majority of the respondents (89.2%) were renew family member ID timely and paid the renewal ID cost, (100%) were covered by self-sponsor. Among those respondents the amount of expenditure cost to register and renewed ID, (70.2%), (15.4%), and (14.4%) were found the interval from, 240-350, 351-450, and 451-1000 ETB with decreasing order respectively.
As Table 2, indicated (80%) of respondents family members had encountered an illness in the past one year. Of which, (80%) got a medical treatment from different health facility. From those respondents, (17.5%), (46.5%) and (36%) of them were from public health center, private health center and government hospital respectively. And (86.4%), respondents that it took >60 minutes to reach the health facility. Among 285 sampled respondents, (43.2%) were CBHI package fulfil the needs of household treatment and majority of the respondents (72.6%) said that CBHI facility provided good services. It can be understood that, (45.6%) of the respondents rated their perceived quality of health care service in the district as low, while the overall CBHI service level was poor(66.7). The main challenges utilization of health services in government health institution, (34.2%), (32.7%), (26.3%),(4.2%) and (2.6%) were absence of available medicine, poor service delivery, lack of enough laboratory equipment, health professionals not have good behavior and shortage of ambulance services respectively.
Table 2
The characteristics of respondents by the levels of WTJ, health status and service utilization in North Mecha Woreda, West Gojjam Zone, Amhara region, Ethiopia
Variables
|
Responses
|
Frequency (N)
|
Percentage (%)
|
Willingness to join CBHI
|
Yes
|
259
|
90.9
|
No
|
26
|
9.1
|
When you join CBHI
|
Before one year ago
|
44
|
15.4
|
Before two year ago
|
72
|
25.3
|
Before three year ago
|
102
|
35.8
|
Before four ago
|
67
|
23.5
|
Join CBHI have advantage
|
Yes
|
266
|
93.3
|
No
|
19
|
6.7
|
Benefits of join in CBHI
|
Reduce OOP expenditure
|
231
|
86.8
|
Improve health
|
22
|
8.3
|
Reduce the risk of Severity
|
6
|
2.3
|
Foster productivity
|
7
|
2.6
|
Willingness to pay CBHI
|
Yes
|
256
|
89.8
|
No
|
29
|
10.2
|
CBHI premium is affordable
|
Yes
|
200
|
70.2
|
No
|
85
|
29.8
|
Renew your & family member ID timely
|
Yes
|
256
|
89.2
|
No
|
29
|
10.2
|
Paid registration& renewal ID cost
|
Self-sponsor
|
285
|
100
|
Amount of expenditure cost to register and renewed ID
|
240-350
|
200
|
70.2
|
351-450
|
44
|
15.4
|
451-1000
|
41
|
14.4
|
Had family members experience of illness in the past one year
|
Yes
|
228
|
80
|
No
|
57
|
20
|
Got a medical treatment
|
Yes
|
228
|
80
|
No
|
57
|
20
|
Place of treatment
|
Public health center
|
40
|
17.5
|
Private health center
|
106
|
46.5
|
Government hospital
|
82
|
36
|
Distance home to health facility in minutes
|
<60 minutes
|
31
|
13.6
|
>60 minutes
|
197
|
86.4
|
Time waited to see medical doctor
|
<30 minutes
|
7
|
3.1
|
30-60 minutes
|
43
|
18.9
|
1- 3 hours
|
78
|
34.2
|
3-6 hours
|
59
|
25.9
|
6 hours &more
|
36
|
15.8
|
More than one day
|
5
|
2.2
|
CBHI package fulfil the needs of HH treatment
|
Yes
|
123
|
43.2
|
No
|
162
|
56.8
|
CBHI health facilities provided a good service
|
Yes
|
207
|
72.6
|
No
|
78
|
27.4
|
Perceived quality of health care service in the district
|
Very low
|
5
|
1.8
|
Low
|
130
|
45.6
|
Medium
|
100
|
35.1
|
High
|
39
|
13.7
|
Very high
|
11
|
3.9
|
Overall CBHI service level
|
Poor
|
190
|
66.7
|
Good
|
95
|
33.3
|
Challenges to use services in government health institution
|
Absence of available medicine
|
65
|
34.2
|
Lack of enough laboratory equipment
|
50
|
26.3
|
Shortage of ambulance service
|
5
|
2.6
|
Poor service delivery
|
62
|
32.7
|
Health professionals do not have good behavior
|
8
|
4.2
|
Filed survey, 2020/21 |
Factors Associated With Willingness To Join Cbhi
Bivariate and multivariate analysis of logistic regression model were carried out to identify factors associated with willingness to join CBHI scheme. Variables with p-value of less than 0.2 in bivariate analysis were entered to multivariate analysis. The study revealed that household heads whose residence in urban area ,occupation working as merchant compared to farmer, occupation employed in merchant compared government employee, willingness to pay, join in CBHI scheme have advantage ,CBHI packages fulfil the needs of HH treatment and CBHI health facilities provided good services, were significantly associated with join in CBHI at p-value<0.05 .
Table 3
Bivariate and multivariate analysis of factors associated with willingness to join community-based health insurance among households in North Mecha Woreda, West Gojjam Zone, Amhara region, Ethiopia
Variables
|
Willingness to
Join CBHI
|
Odds Ratio(OR)
|
Yes
|
No
|
B
|
COR(95%CI)
|
AOR(95%CI)
|
Place of residence
|
|
|
|
|
Rural
|
209
|
22
|
-0.999(0.395)
|
0.368( 0.169-0.802) 0.012
|
1.484(2.343-6.427)0.025
|
Urban
|
42
|
12
|
|
1
|
1
|
Religion
|
|
|
|
|
|
Orthodox
|
221
|
25
|
-0.975(0.485)
|
0.377(0.161-0.884) 0.025
|
1.624(0.334-7.900) 0.548
|
Others
|
30
|
9
|
|
1
|
1
|
Educational level of HH
|
|
|
|
Illiterate
|
119
|
7
|
-1.545(-1.084)
|
0.213(0.083-0.547) 0.001
|
0.338(0.061-1.875) 0.215
|
Read & write
|
74
|
11
|
-0.618 (-0.629)
|
0.539(0.232-1.250) 0.150
|
0.533(0.115-2.466) 0.421
|
Primary &above
|
58
|
16
|
|
1
|
1
|
Occupational status of HH
|
|
|
|
Farming
|
165
|
8
|
-2.296(-2.321)
|
0.101(0.038-0.266) 0.000
|
0.098(0.027-0.363) 0.001
|
House wife
|
19
|
3
|
-1.115(-1.209)
|
0.328(0.082-1.311) 0.115
|
0.298(0.060-1.491) 0.141
|
Gov’t employee
|
14
|
1
|
-1.908(-3.000)
|
0.148(0.018-1.253) 0.080
|
0.050(004-0.639) 0.021
|
Laborer
|
26
|
9
|
-0.330(-0.902)
|
0.719(0.263-1.966) 0.520
|
0.406(0.119-1.386) 0.150
|
Merchants
|
27
|
13
|
|
1
|
1
|
Willingness to pay CBHI
|
|
|
|
Yes
|
235
|
21
|
-2.207(-2.330)
|
0.110(0.047-0.259)0.000
|
0.097(0.035-0.267) 0.000
|
No
|
16
|
13
|
|
1
|
1
|
CBHI premium is affordable
|
|
|
|
Yes
|
185
|
15
|
-1.267(-0.544)
|
0.282(0.135-0.586)0.001
|
0.580(0.246-1.368)0.213
|
No
|
66
|
19
|
|
1
|
1
|
Join in CBHI have advantage
|
|
|
Yes
|
244
|
22
|
-2.945(-2.525)
|
0.053(0.019-0.147)0.000
|
0.080(0.027-0.236)0.000
|
No
|
7
|
12
|
|
1
|
1
|
CBHI package fulfil the needs of HH treatment
|
|
Yes
|
118
|
5
|
-1.638(-1.133)
|
0.194(0.073-0.518) 0.001
|
0.322(0.111-0.936)0.037
|
No
|
133
|
29
|
|
1
|
1
|
CBHI health facilities provided a good service
|
|
/
|
Yes
|
193
|
14
|
-1.559(-1.313)
|
0.210(0.100-0.442) 0.000
|
0.269(0.118-0.613)0.002
|
No
|
58
|
20
|
|
1
|
1
|
Filed survey, 2020/21 |