Community based health insurance (CBHI) system in Southern Ethiopia: an evaluation of communication approach

Effective communication is a critical determinant of the success of community-based health insurance (CBHI) schemes, as it shapes public awareness, trust, and willingness to enroll. In Ethiopia, particularly in rural and underserved areas, the effectiveness of communication approaches remains underexplored despite their centrality to improving health service utilization and financial protection. This study explores the effectiveness of communication approaches employed in the implementation of the Community-Based Health Insurance (CBHI) system in Ethiopia, with a focus on the East Guji Zone of the Oromia Region. Using a qualitative research design, data were collected through in-depth interviews, focus group discussions (FGDs), and document analysis. The study is grounded in Social Learning Theory and the Diffusion of Innovation model, complemented by the Social and Behaviour Change Communication (SBCC) frameworks. Findings reveal that while various communication channels: interpersonal, community-oriented, and mass media are utilized, communication efforts are largely uncoordinated, lacking a clearly defined strategy or professional guidance. Public mobilization efforts are inconsistent and often driven by non-expert personnel without adequate training. Consequently, communities exhibit limited understanding of CBHI principles, objectives, and benefits, resulting in mixed perceptions and low enrollment rates. The study recommends the development and implementation of a structured communication strategy guided by trained professionals to improve public awareness, engagement, and participation in the CBHI program.