Community-Based Health Insurance Schemes

Due to the limited ability of publicly financed health systems in developing countries to provide adequate access to health care, community-based health financing has been proposed as a viable option. This has led to the implementation of a number of Community- Based Health Insurance (CBHI) schemes, in several developing countries. To assess the ability of such schemes in meeting their stated objectives, this study systematically reviews the existing empirical evidence on three outcomes – access to schemes, effect on health care utilization and effect on financial protection. In addition to collating and summarizing the evidence we analyse the link between key scheme design characteristics and their effect on outcomes and comment on the role that may be played by study characteristics in influencing outcomes. The review shows that the ultra-poor are often excluded and at the same time there is evidence of adverse selection. The bulk of the studies find that access to CBHI is associated with increased health care utilization, especially with regard

Linking Social Protection Schemes: The Joint Effects of a Public Works and a Health Insurance Programme in Ethiopia

In developing countries and in particular in sub-Saharan Africa, social protection schemes tend to operate in silos. However, schemes targeting the same geographical areas may have synergies that have not yet been examined, and which are worth scrutinising. This paper contributes to this knowledge gap by examining the joint impacts of two social protection programmes in Ethiopia, that is, the Productive Safety Net Programme and a Community Based Health Insurance Scheme. Based on three rounds of individual level panel data and several rounds of qualitative interviews, we find that individuals covered by both programmes, as opposed to neither or only one of the two programmes, provide greater labour supply, have larger livestock holdings, and have a lower amount of outstanding loans. Furthermore, joint participation is associated with greater use of modern health care facilities as compared to participating only in the safety net programme. These results show that bundling of interventions enhances protection against multiple risks and that linking social protection schemes yields more than the sum of their individual effects

Enrolment in Ethiopia’s Community Based Health Insurance Scheme

In June 2011, the Government of Ethiopia rolled out a pilot Community Based Health Insurance (CBHI) scheme. This paper assesses scheme uptake. We examine whether the scheme is inclusive, the role of health status in inducing enrolment and the effect of the quality of health care on uptake. By December 2012, scheme uptake had reached an impressive 45.5 percent of target households. We find that a household’s socioeconomic status does not inhibit uptake and the most food-insecure households are substantially more likely to enrol. Recent illnesses, incidence of chronic diseases and self-a

Containing the spread of COVID-19 in Ethiopia

Ethiopia has a low although rising number of confirmed COVID-19 cases. Despite these low figures, stringent measures have been implemented since mid-March. In this viewpoint we describe the prevention and preparation measures taken in Ethiopia and comment on the consequences, challenges and strengths of the measures, keeping in mind the Ethiopian context

Impact of Ethiopia’s Community Based Health Insurance on household economic welfare

In 2011, the Government of Ethiopia launched a pilot Community-Based Health Insurance (CBHI) scheme. This paper uses three rounds of household survey data, collected before and after the introduction of the CBHI pilot, to assess the impact of the scheme on household consumption, income, indebtedness and livestock holdings. We find that enrolment leads to a 5 percentage point – or 13 percent – decline in the probability of borrowing and is associated with an increase in household income. There is no evidence that enrolling in the scheme affects consumption or livestock holdings. Our results show that the scheme reduces reliance on potentially harmful coping responses such as borrowing. This paper adds to the relatively small body of work which rigorously evaluates the impact of CBHI schemes on economic welfare

The impact of Ethiopia’s pilot community based health insurance scheme on healthcare utilization and cost of care

In recent years there has been a proliferation of Community Based Health Insurance (CBHI) schemes designed to enhance access to modern health care services and provide financial protection to workers in the informal and rural sectors. In June 2011, the Government of Ethiopia introduced a pilot CBHI scheme in rural parts of the country. This paper assesses the impact of the scheme on utilization of modern health care and the cost of accessing health care. It adds to the relatively small body of work that provides a rigorous evaluation of CBHI schemes. We find that enrolment leads to a 30 to 41 percent increase in utilization of outpatient care at public facilities, a 45 to 64 percent increase in the frequency of visits to public facilities and at least a 56 percent decline in the cost per visit to public facilities. The effects of the scheme on out-of-pocket spending are not as clear. The impact on utilization and costs combined with a high uptake rate of almost 50 percent within two years of scheme establishment, suggests that this scheme has the potential to meet the goal of universal access to health care

Self-reported health care seeking behavior in rural Ethiopia: Evidence from clinical vignettes

Between 2000 and 2011, Ethiopia rapidly expanded its health-care infrastructure recording an 18-fold increase in the number of health posts and a 7-fold increase in the number of health centers. However, annual per capita outpatient utilization has increased only marginally. The extent to which individuals forego necessary health care, especially why and who foregoes care are issues that have received little attention in the context of low-income countries. This paper uses five clinical vignettes covering a range of context-specific child and adult-related diseases to explore the health-seeking behavior of rural Ethiopian households. We find almost universal preference for modern care. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult-related conditions with households in higher consumption quintiles more likely to seek care in health centers, private/NGO clinics as opposed to health posts. Similarly, delays in care-seeking behavior are apparent mainly for adult-related conditions. The differences in care seeking behavior between adult and child related conditions may be attributed to the recent spread of health posts which have focused on raising awareness of maternal and child health. Overall, the analysis suggests that the lack of health-care utilization is not driven by the inability to recognize health problems or due to a low perceived need for modern care but due to other factors

Healthcare-seeking behaviour in rural Ethiopia: Evidence from clinical vignettes

__Abstract__ Objectives: To investigate the determinants of healthcare-seeking behaviour using five contextrelevant clinical vignettes. The analysis deals with three issues: whether and where to seek modern care and when to seek care. Setting: This study is set in 96 villages located in four main regions of Ethiopia. The participants of this study are 1632 rural households comprising 9455 individuals. Primary and secondary outcome measures: Probability of seeking modern care for symptoms related to acute respiratory infections/pneumonia, diarrhoea, malaria, tetanus and tuberculosis. Conditional on choosing modern healthcare, where to seek care (health post, health centre, clinic and hospital). Conditional on choosing modern healthcare, when to seek care (seek care immediately, the next day, after 2 days, between 3 days to 1 week, a week or more). Results: We find almost universal preference for modern care. Foregone care ranges from 0.6% for diarrhoea to 2.5% for tetanus. There is a systematic relationship between socioeconomic status and choice of providers mainly for adult-related conditions with households in higher consumption quintiles more likely to seek care in health centres, private/Non-Government Organization (NGO) clinics as opposed to health posts. Delays in care-seeking behaviour are apparent mainly for adult-related conditions and among poorer households. Conclusions: The analysis suggests that the lack of healthcare utilisation is not driven by the inability to recognise health problems or due to a low perceived need for modern care

Coping with shocks in rural Ethiopia

Based on household survey data and event history interviews undertaken in a highly shock prone country, this paper investigates which shocks trigger which coping responses and why? We find clear differences in terms of coping strategies across shock types. The two relatively covariate shocks, that is, economic and natural shocks are more likely to trigger reductions in savings and in food consumption while the sale of assets and borrowing is less common. Coping with relatively idiosyncratic health shocks is met by reductions in savings, asset sales and especially a far greater reliance on borrowing as compared to other shocks. Reductions in food consumption, a prominent response in the case of natural and economic shocks is notably absent in the case of health shocks. Across all shock types, households do not rely on gifts from family and friends or on enhancing their labour supply as coping approaches. The relative insensitivity of food consumption to health shocks based on the shocks-coping analysis presented here is consistent with existing work which examines consumption insurance. However, our analysis leads to a different interpretation. We argue that this insensitivity should not be viewed as insurability of food consumption against health shocks but rather as an indication that a reduction in food consumption is not a viable coping response to a health shock as it does not provide cash to meet health care needs