Exploring Factors Influencing Family’s Enrollment in Community-Based Health Insurance in the City of Gondar Peri-Urban Community, Northwest Ethiopia: A Health Belief Model Approach

Abstract

Background

A research gap exists in finding practical solutions to provide affordable and accessible health insurance coverage to improve CBHI enrollment and sustainability to people in resource-poor settings and contribute to achieving universal health coverage (UHC) in Ethiopia. This research was initiated to analyze the role of community trust in scheme management and health choice to identify significant factors based on the health belief model (HBM). This psychological framework explains and predicts health behavior by considering individual perceptions.

Methods

Cross-sectional information was gathered from 358 families, and original facts were utilized. Descriptive data and the Binary logistics in the econometric model were applied for data analysis.

Findings

The descriptive findings demonstrated that other variables were established to possess a significant consequence except for job and occupation variables. The results of the logistic regression model showed that the distance of the nearest health station from the family’s home in a minute [AOR (95% CI) =0.177 (0.015, −0.399)], being a member of the families having an official position in local government or cultural structure [AOR (95% CI) =0.574 (0.355, 0.793)], having an experience of visiting health facilities [AOR (95% CI) =0.281 (0.166, 0.396)], and perceiving the local CBHI scheme management as trustworthy [AOR (95% CI) =0.404 (0.233, 0.575)] were positively associated with family enrollment in the CBHI scheme. On the other hand, being a member of the “rotating saving and credit association” (ROSCA) [AOR (95% CI) =−.299 (−.478, −0.120)] was negatively associated with the family’s enrollment in the CBHI scheme.

Conclusion

Trust in CBHI scheme management, family’s experience of visiting health facilities, and distance from the nearest health station were essential factors influencing enrollment in CBHI schemes. “Rotating saving and credit association” (ROSCA) ° negatively and statistically significantly impacted the family’s CBHI enrolment status. Income level was not associated with enrollment.

Keywords:

• health belief model
• community-based health insurance
• enrollment
• dropout
• the city of Gondar Peri-Urban community

Abbreviations

CBHI, Community-Based Health Insurance; EHIA, Ethiopian Health Insurance Agency; EFY, Ethiopian Fiscal Year; ETB, Ethiopian Birr; FMoH, Federal Minister of Health; GDP, Gross Domestic Product; OOP, Out of Pocket; SSA, Sub-Saharan Africa; USD, United States Dollar; WHO, World Health Organization.

Data Sharing Statement

The data is available from the corresponding author upon request.

Approval of Ethics and Participation Consent

The study was conducted under the Declaration of Helsinki after obtaining ethical clearance from the Central Gondar Health Department (reference number: ማጎጠ 1/19/1952 date 2023-04-26. An information sheet was developed to provide participants with clear information on the research topic, objectives, confidentiality of responses, and study benefits. Verbal consent was obtained from all participants before data collection, as the Ethiopian ethics guideline permitted non-sensitive topics with no risk to participants. Participants were informed of their right to withdraw from the study at any time, and only those who voluntarily agreed to participate were included. The review committee approved the procedure, and confidentiality was maintained by using codes instead of personal identifiers in data collection tools. All paper-based and computer-based data were stored in secure locations and accessed only by the research team. Data sharing will be conducted under ethical and legal rules.

Acknowledgments

The author thanks Dr. Xu Mengmeng for her unreserved support throughout the research process. I am also grateful to the heads and experts of the central Gondar health departments, data collectors, and supervisors for their valuable roles in the success of this study.

Disclosure

The author affirms no conflicts of interest in this work.