DETERMINANTS OF HOUSEHOLD'S ENROLMENT ON COMMUNITY BASED HEALTH INSURANCE SCHEME IN NORTH WOLLO ZONE, THE CASE OF HABRU WOREDA, AMHARA REGION

Abstract In Ethiopia health insurance is among the major strategies of health sector of which CBHI is one category of the two health insurance strategy (SHI & CBHI). As the primary goal of health insurance strategy was to improve financial access to health care services, improve quality of health care services, increase resource mobilization in the health sector, strengthen community participation in the management of health services; challenges of low level of enrollment is critical issue in the study area. This study was initiated with the objective of analyzing the role of communities trust on scheme management and health choice for enrolment status and identifying major factors determining household’s enrolment status in CBHI scheme. For the purpose of the study a cross sectional data were collected from 358 sample households and primary data was used. Interview schedule was used to collect primary data from the sampled households. For the purpose of data analysis, descriptive statistics and Binary logit econometric model were applied. The descriptive results of the study showed that household head age and educational level, family size, annual income, cultivated land holding size, livestock ownership, frequency of visiting modern health facilities, distance to the nearest health facility, holding official position, participating in meetings, awareness level of household head, health choice of the household and quality and adequate service provision of public health facilities and trustworthiness of the local scheme management were found to have a significant effects on households enrolment status. From the Binary logit results, household head education level, travel time to the nearest health facilities, having or still holding an official position in government or cultural structures, participating in different local meetings, frequency of visiting modern health facilities per year and trustworthiness of the local scheme management were important factors influencing enrollment decisions of households in the study area. Based on these findings, the researcher recommended that primary focus is on the level of awareness of the community, the community participation in the scheme management should be strengthened to get their trust on the scheme management and high emphasis needs by regional and federal states to the availability of health facilities quality and quantity wise within reasonable distance. Generally strong awareness creation, adequate and quality service provision at local government as well as local scheme managements could create a better perception and trust of the community towards new idea of CBHI scheme would enhance enrollment.