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

Figures & data

Figure 1 Conceptual framework.

Note: Author’s own Formulation (2023).

Table 1 Enrolled and Non-Enrolled Households by Socioeconomic Factors

Variable	Households Enrolment status	N	Average	Standard Deviation	Average Difference	t -score
Landholding Size	Not Enrolled	215	0.964186	0.8245481		3.5193
	Enrolled	143	1.311259	0.9687947
	Total	358	1.102821	0.8999148	−0.3470727
Livestock Holding in TLU	Not Enrolled	213	3.540563	2.720092		2.5974
	Enrolled	143	4.462657	3.613225
	Total	356	0.910955	3.137767	−0.922094
Household Annual Income	Not Enrolled	215	33,751.79	17,977.06		4.2044
	Enrolled	143	42,460.23	19,963.22
	Total	358	37,230.3	19,248.01	8708.434

Note: Own Survey Data (2023).

Table 2 Enrolment Status by Institutional Factors (Distance and Frequency of Visit)

Variable	Household Enrolment Status	N	Average	Standard Deviation	Average Difference	t-score
Distance in Minute	Not-Enrolled	215	58.90698	22.14735		8.781
	Enrolled	143	39.12587	19.98516
	Total	358	51.00559	23.38857	19.7811
Frequency of visiting Healthy facility	Not-Enrolled	215	0.8372093	0.993677		12.835
	Enrolled	143	2.412,587	1.223759
	Total	358	1.46648	1.335885	−1.575378

Note: Own Survey Data (2023).

Table 3 Distance to the Nearest Health Station

Enrolment Status	Living Near	%	Living Not-far	%	Living Far	%	Total	%
Not Enrolled	53	48.15	50	48.08	112	77.78	215	60.06
Enrolled	57	51.85	54	51.92	32	22.22	143	39.94
Total	110	30.73	104	29.05	144	40.22	358	100

Note: Own Survey Data (2023).

Table 4 Enrolment Status by Official Position & Participation in Local Meetings

Household Enrolment Status
Variable			Not Enrolled (N=215)	Enrolled (N=143)	Total (N=358)	x2_value
Officially position held	No	N	209	102	311	50.4
		%	97.21	71.33	86.87
	Yes	N	6	41	47
		%	2.79	28.67	13.13
Participation in different local meetings	No	N	117	45	162	18.3
		%	54.42	31.47	45.25
	Yes	N	98	98	196
		%	45.58	68.53	54.75

Note: Own Survey Data (2023).

Table 5 Enrolment and Knowledge About the Scheme

Household Enrolment Status
Variable		Not Enrolled (N=215)	Enrolled (N=143)	Total (N=358)
Do you have information About the CBHI Scheme	No	45	0	45
		(20.93)	(0.00)	(12.57)
	Yes	170	143	313
		(79.07)	(100.00)	(87.43)
Knowledge about time and amount of Premium payment	No	136	5	141
		(63.26)	(3.50)	(39.39)
	Yes	79	138	217
		(36.74)	(96.50)	(60.61)
Knowledge of Contract renewal time	No	184	17	201
		(85.58)	(11.89)	(56.15)
	Yes	31	126	157
		(14.42)	(88.11)	(43.85)
Knowledge of Health Facility Utilization if Become CBHI Members	No	190	37	227
		(88.37)	(25.87)	(63.41)
	Yes	25	106	131
		(11.63)	(74.13)	(36.59)

Note: Own Survey Data (2023).

Table 6 Enrolment Status by Awareness Level

Variable	Household Enrolment Status	N	Average	Standard Deviation	Average Difference	t-score
Awareness Level of Household head	Not-Enrolled	215	3.214,884	0.7170565		15.0348
	Enrolled	143	4.236364	0.564008
	Total	358	3.622905	0.8280993	−1.02148

Note: Own Survey Data (2023).

Table 7 Motives for Enrolment Status of Sample Households

Reason for Enrolling in the CBHI	Frequency	Percent (%)	Reason for not-Enrolled in the CBHI Program	Frequency	Percent (%)
Sickness and injury exist in my household frequently	23	16.08	Sickness and injury do not happen in my household frequently	32	14.88
Our household member needs health care	20	20.28	The registration and premium fees are not affordable	54	35.12
To finance health care expenses	19	13.29	We do not understand sufficiently regarding the CBHI program	53	24.65
The government pays the CBHI registration fee and premium	8	5.59	There is limited availability of health service	14	6.51
Premium is low compared to the OOP payment to obtain medical treatment	51	35.66	The benefits packages do not meet our household needs	4	1.86
Pressure from Kebele/Gotte administrators	13	9.09	The quality of health care service is low	17	7.91
Total	143	100	Lack of confidence in scheme management	16	7.44
			Want to wait to confirm the benefit of the scheme from others	16	7.44
			Other reasons	9	4.19
			Total	215	100

Note: Own Survey Data (2023).

Table 8 Sample Households’ Healthcare Care Choice

Household Enrolment Status
	Not-Enrolled (N=215), N (%)	Enrolled (N=143), N (%)	Total (N=358), N (%)
Health Choice of the Household Modern-public	56	128	184
	(26.05)	(89.51)	(51.40)
Modern-private	51	0.3	0.54
	(23.72)	(2.10)	0 (15.08)
Cultural-baptism (Tsebel)	75	6	81
Cultural herbs & others	7	0	7
	(34.88)	(0.00)	(1.96)
No choice	26	6	32
	(12.09)	(4.20)	(8.94)

Note: Own Survey Data (2023).

Table 9 Logistic Regression Analysis for CBHI Family’s Enrollment in CBHI in the City of Gondar Peri-Urban community, Northwest Ethiopia

Variable	AOR (Adjusted Odds Ratios)	Std. Err.	COR [95% C.I.]		X
Sex*	0.1860597	0.1442	-0.096569	0.468689	0.136872
Age	0.0020539	0.0058	-0.009311	0.013419	46.1927
Family size of the household	-0.0056752	0.03006	-0.064584	0.053233	5.42458
The proportion of family size between 14 to 64 years old.	0.0978372	0.34111	-0.570717	0.766392	0.513973
The proportion of families above 64 years old	0.7806609	0.61183	0.418508	1.97983	0.044496
Cultivated land size of the household	0.0883689	0.07925	-0.066963	0.243701	1.10282
Number of animals having a household in TLU	0.0201623	0.02354	-0.025975	0.0663	3.88911
Distance of the nearest health station from household home in a minute	0.1768816**	0.08274	0.014706	0.339057	0.547486
Do you participate in different local meetings? 1=yes *	0.1768816**	0.08274	0.014706	0.339057	0.547486
Does your household graduate in HEP and become certified? 1=yes *	-0.113937	0.09539	-0.300892	0.073018	0.248603
Do your household participate and use different credit packages? 1=yes *	-0.0511655	0.0866	-0.220899	0.118568	0.575419
Are you a member of the local Funeral Association (LFA)? 1=yes *	0.1288264	0.12375	-0.113711	0.371364	0.863128
Are you or any member of your household a member of ROSCA? 1=yes *	-0.299047***	0.0914	-0.478179	-0.119915	0.268156
Any member of the household having an official position in local government or cultural structure *	0.5742591***	0.11176	0.355221	0.793297	0.131285
Frequency of visiting health facilities by the household for the last year*	0.2807832***	0.05873	0.165667	0.395899	1.46648
Do you think that the local CBHI scheme management is trustworthy? 1=yes *	0.4041215***	0.08714	0.233337	0.574906	0.519553
Household head education condition level *	0.1854168*	0.10465	-0.019702	0.390536	0.410615
The income level of households converted into natural legalism	0.0696579	0.08622	-0.099325	0.23864	10.3792
Health Choice of the Household Head 1= Modern Healthcare *	-0.2170265	0.15981	-0.530257	0.096204	0.664804
Quality of HCS from public health facilities as the respondent perception; 1=neutral*	-0.0301635	0.09719	-0.220649	0.160322	0.396648
Quality of HCS from public health facilities as the respondent perception; 1=poor*	-0.0703974	0.10879	-0.283631	0.142836	0.354749 (*)

Notes: Own Survey Data (2023). (***p<0.01, **p<0.05, *p<0.1).