Assessment of Voluntary Enrollment and Associated Factors in Community-based Health Insurance in Lideta Sub-city, Addis Ababa, Ethiopia

<i>Background: </i>A community-based health insurance scheme is an effective way to achieve universal health service coverage by offering financial protection against healthcare costs. This study aimed to assess the voluntary enrollment and associated factors in community-based health insurance in the Lideta sub-city.<i> Methods: </i>A cross-sectional study was conducted from July 23 to August 26, 2024, using a stratified sampling method followed by simple random sampling on 643 participants using a structured, pre-tested closed questionnaire. <I>D</I>ata was collected by Kobo Toolbox software and exported to STATA version 17.0 for analysis. Descriptive analysis and cross-tabulation was performed to present the data. Both bivariate and multivariate logistic regression analyses were computed with a 95% confidence interval. Variables with a p-value of less than 0.05, along with their Adjusted Odds Ratios (AOR), were identified as predictors of the outcome variables in the study. <i>Results: </i>In the current study the voluntary enrollment rate in community based health insurance was 68.6%. In the study, as age increased in one year, enrollment increased by 0.033 [95% CI: 0.006, 0.056]; the higher income indicating 0.771 [95% CI: -1.862, 0.848] increased enrollment in community based health insurance keeping other variables constant. However, availability [-0.551, (95% CI: -1.053, 0.078)], and accessibility [-0.565, (95% CI: -1.097, -0.005)] of quality health services are negatively correlated with enrollment in community based health insurance. <i>Conclusions and Recommendations: </i>The voluntary enrollment rate in community-based health insurance services was 68.6%. Age and income were positively associated with enrollment, while accessibility and the availability of quality healthcare were negatively associated. Therefore, the relevant organizations and stakeholder should take the following actions as recommendations: launch targeted awareness campaigns, address barriers for waiting time, enhance strategies that improve service availability and accessibility, and offer subsidy methods, and conduct qualitative research such as in-depth individual interviews and delphi technique to further explore the barrier for community based health insurance enrollment to gain further insights.