1
|
Shiferaw YA, Yilema SA, Moyehodie YA. A Hierarchical Bayesian approach to small area estimation of health insurance coverage in Ethiopian administrative zones for better policies and programs. HEALTH ECONOMICS REVIEW 2024; 14:29. [PMID: 38625443 PMCID: PMC11020459 DOI: 10.1186/s13561-024-00498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
Sample surveys are extensively used to provide reliable direct estimates for large areas or domains with enough sample sizes at national and regional levels. However, zones are unplanned domains by the Demographic and Health Survey (DHS) program and need more sample sizes to produce direct survey estimates with adequate precision. Conducting surveys in small areas (like zones) is too expensive and time-consuming, making it unfeasible for developing countries like Ethiopia. Therefore, this study aims to use the Hierarchical Bayes (HB) Small Area Estimation (SAE) model to estimate the Community-Based Health Insurance (CBHI) coverage at the zone levels in Ethiopia. To achieve this, we combined the 2019 Ethiopia Mini-Demographic and Health Survey (EMDHS) data with the 2007 population census data. SAE has addressed the challenge of producing reliable parameter estimates for small or even zero sample sizes across Ethiopian zones by utilizing auxiliary information from the population census. The results show that model-based estimates generated by the SAE approach are more accurate than direct survey estimates of CBHI. A map of CBHI scheme coverage was also used to visualize the spatial variation in the distribution of CBHI scheme coverage. From the CBHI scheme coverage map, we noticed notable variations in CBHI scheme coverage across Ethiopian zones. Additionally, this research identified areas with high and low CBHI scheme coverage to improve decision-making and increase coverage in Ethiopia. One of the novelties of this paper is estimating the non-sampled zones; therefore, the policymakers will give equal attention similar to the sampled zones.
Collapse
Affiliation(s)
- Yegnanew A Shiferaw
- Department of Statistics, University of Johannesburg, PO Box 524, Johannesburg, 2006, South Africa
| | - Seyifemickael Amare Yilema
- Department of Statistics, College of Natural and Computational Science, Debre Tabor University, PO Box 272, Debre Tabor, Ethiopia.
| | - Yikeber Abebaw Moyehodie
- Department of Statistics, College of Natural and Computational Science, Debre Tabor University, PO Box 272, Debre Tabor, Ethiopia
| |
Collapse
|
2
|
Terefa DR, Geta ET, Shama AT, Desisa AE. What role does community-based health insurance play in the utilisation of health services among households in Ethiopia? A community-based comparative cross-sectional study. BMJ Open 2024; 14:e078733. [PMID: 38423776 PMCID: PMC10910592 DOI: 10.1136/bmjopen-2023-078733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE In Ethiopia, despite increased health service coverage, health service utilisation remains very low. However, evidence on the level of health service utilisation between insured and non-insured households in the study area was scanty. Therefore, this study aimed to assess health service utilisation and its predictors among insured and non-insured households of community-based health insurance in the East Wallaga Zone, Oromia region, Ethiopia, in 2022. METHODS A community-based comparative cross-sectional study was employed. Data were collected using semi-structured interviewer-administered pretested questionnaire by face-to-face interviewing of heads of the households or spouse from 1 January 2022 to 30 January 2022, on 900 (450 insured and 450 non-insured). Epi-Data V.3.1 and Statistical Package for Social Science V.26 were used for data entry and analysis, respectively. The association between dependent (health service utilisation) and independent variables was analysed first using binary logistic regression. Multivariable logistic regression was used to identify potential predictor variables at a p<0.05. RESULTS About 60.5% (95% CI 55.7% to 64.8%) of insured households had used health services compared with 45.9% (95% CI 41.4% to 50.9%) of non-insured households in the last 6 months. Family health status (Adjusted Odd Ratio (AOR) and 95% CI=2.74 (1.37 to 5.45), AOR and 95% CI=1.62 (1.01 to 3.14)); family with chronic disease (AOR and 95% CI=8.33 (5.11 to 13.57), AOR and 95% CI=4.90 (2.48 to 9.67)); perceived availability of drugs (AOR and 95% CI=0.34 (0.15 to 0.79), AOR and 95% CI=3.97 (1.69 to 9.34)); perceived transportation cost (AOR and 95% CI=0.44 (0.21 to 0.90), AOR and 95% CI=1.71 (1.00 to 2.93)); participated in indigenous community insurance (AOR and 95% CI=3.82 (1.96 to 7.45), AOR and 95% CI=0.13 (0.06 to 0.29)) and >10 km travel distance from nearby health facilities (AOR and 95% CI=1.52 (1.02 to 2.60), AOR and 95% CI=8.37 (4.54 to 15.45)) among insured and non-insured households, respectively, were predictors of health service utilisation. CONCLUSION Insured households were more likely to utilise health services compared with non-insured households. Family health status, family with chronic disease, perceived availability of drugs, perceived transportation cost, participation in indigenous community insurance and >10 km travel were predictors of health service utilisation among insured and non-insured households. Hence, the greatest emphasis should be given to enhancing enrolment in the community-based health insurance scheme to achieve universal health coverage.
Collapse
Affiliation(s)
- Dufera Rikitu Terefa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Edosa Tesfaye Geta
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Adisu Tafari Shama
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Adisu Ewunetu Desisa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| |
Collapse
|
3
|
Sendekie AK, Gebremichael AH, Tadesse MW. Enrollment and clients' satisfaction with a community-based health insurance scheme: a community-based survey in Northwest Ethiopia. BMC Health Serv Res 2024; 24:70. [PMID: 38218770 PMCID: PMC10787395 DOI: 10.1186/s12913-024-10570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/05/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Although the Ethiopian government has implemented a community-based health insurance (CBHI) program, community enrollment and clients' satisfaction have not been well investigated in Gondar Zuria district, Northwest Ethiopia. This study assessed CBHI scheme enrollment, clients' satisfaction, and associated factors among households in the district. METHODS A community-based cross-sectional survey assessed CBHI scheme enrollment and clients' satisfaction among households in Gondar Zuria district, Northwest Ethiopia, from May to June 2022. A systematic random sampling method was used to select the study participants from eligible households. A home-to-home interview using a structured questionnaire was conducted. Data were analysed using the statistical packages for social sciences version 26. Logistic regression was used to identify variables associated with enrollment and clients' satisfaction. A p-value < 0.05 was considered statistically significant. RESULTS Out of 410 participants, around two-thirds (64.9%) of the participants were enrolled in the CBHI scheme. Residency status (AOR = 1.38, 95% CI: 1.02-5.32; p = 0.038), time taken to reach a health facility (AOR = 1.01, 95% CI: 1.00-1.02; p = 0.001), and household size (AOR = 0.77, 95% CI: 0.67-0.88; p < 0.001) were significantly associated with CBHI scheme enrollment. Two-thirds (66.5%) of enrolled households were dissatisfied with the overall services provided; in particular, higher proportions were dissatisfied with the availability of medication and laboratory tests (88.7%). Household size (AOR = 1.31, 95% CI: 1.01-2.24; p = 0.043) and waiting time to get healthcare services (AOR = 3.14, 95% CI: 1.01-9.97; p = 0.047) were predictors of clients' satisfaction with the CBHI scheme services. CONCLUSION Although a promisingly high proportion of households were enrolled in the CBHI scheme, most of them were dissatisfied with the service. Improving waiting times to get health services, improving the availability of medications and laboratory tests, and other factors should be encouraged.
Collapse
Affiliation(s)
- Ashenafi Kibret Sendekie
- Departement of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Hailu Gebremichael
- Department of Sociology, School of Sociology and Social Work, College of Social Sciences and the Humanities, University of Gondar, Gondar, Ethiopia
| | - Melkamu Workie Tadesse
- School of Economics, College of Business and Economics, University of Gondar, Gondar, Ethiopia.
| |
Collapse
|
4
|
Geta ET, Lushe KA, Desisa AE, Terefa DR, Cheme MC, Shama AT, Lema M. Determinants of community-based health insurance membership renewal decision among rural households in Kellem Wollega zone, Oromia regional state, Ethiopia: a community-based cross-sectional study. Front Public Health 2024; 11:1192991. [PMID: 38239796 PMCID: PMC10794429 DOI: 10.3389/fpubh.2023.1192991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
Background Despite the fact that community-based health insurance (CBHI) is a promising program to achieve the goal of universal health coverage (UHC), it faces challenges that are not only due to low enrollment but also due to membership renewal decision that impact its sustainability. Hence, the study aimed to identify the determinants of CBHI membership renewal decision among rural households in Kellem Wollega zone, Ethiopia. Methods The study was conducted in Kellem Wollega, Ethiopia, among rural households from March 30-April 30, 2022, using a community-based cross-sectional study design. An interviewer-administered structured questionnaire through face-to-face interviews was used. Using a systematic random sampling method, 551 households were selected making 540 (98%) response rates. The data was entered into EPI Data 3.1 and analyzed using SPSS 25 software. Descriptive statistics, binary, and multiple logistic regressions were performed. Using multiple logistic regressions, a significant association between the CBHI membership renewal decision and independent variables was identified, declaring the statistical significance level using a 95% confidence interval (CI) at p < 0.05. Results The overall rate of CBHI membership renewal decision among households was estimated to be 365 (67.6%, 95% CI = 63.7-71.5%). The factors that significantly influenced the households' membership renewal decision were family size (AOR = 0.46, 95% CI = 0.25-0.86), low literacy status (AOR = 0.28 95% CI = 0.12-0.64), lower than middle-level of wealth index (AOR = 9.80, 95% CI = 2.75-34.92), premium affordability (AOR = 4.34, 95% CI = 2.08-9.04), unavailability of services (AOR = 0.26, 95% CI = 0.12-0.55), trusting in health facilities (AOR = 5.81, 95% CI = 2.82-11.94), favorable providers' attitude toward members (AOR = 8.23, 95% CI = 3.96-19.64), good quality of service (AOR = 4.47, 95% CI = 2.28-8.85) and health care seeking behavior (AOR =3.25, 95% CI = 1.32-7.98). Conclusion The overall CBHI membership dropout decision rate among rural households was high, which could affect health service provision and utilization. Therefore, the insurance scheme and contracted health facilities should consider and work on family size and wealth status when membership premiums are calculated, the education level of households when creating awareness about the scheme, building trust in the contracted health facilities by providing all promised benefit packages of health services with good quality, and improving the attitude of health care providers towards the scheme members.
Collapse
Affiliation(s)
- Edosa Tesfaye Geta
- Kellem Wollega Zonal Health Department, Dembi Dollo, Ethiopia
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | | | - Adisu Ewunetu Desisa
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Dufera Rikitu Terefa
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Melese Chego Cheme
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Adisu Tafari Shama
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Matiyos Lema
- Department of Public Health, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
5
|
Han J, Hao Y, Cui N, Wang Z, Lyu P, Yue L. Parenting and parenting resources among Chinese parents with children under three years of age: rural and urban differences. BMC PRIMARY CARE 2023; 24:38. [PMID: 36726105 PMCID: PMC9890422 DOI: 10.1186/s12875-023-01993-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Parenting is essential for children's development and preventing child abuse and neglect. Providing parenting services within the primary health care settings demonstrated effectiveness in improving parenting quality. However, little is known about the status of parenting and parenting resources in rural areas and whether they differ between rural and urban areas in Mainland China. OBJECTIVE This study aimed to examine the rural-urban differences in parenting and availability of, utilization of, and need for parenting resources among Chinese parents with children under three years of age. PARTICIPANTS AND SETTING A total of 425 parents of children under three years of age participated in an online survey between March and May 2020. METHODS The Parenting and Family Adjustment Scale and Child Adjustment and Parenting Efficacy Scale were used to assess parenting, family adjustment, and parenting efficacy. The availability of, utilization of, and need for parenting resources were measured using self-developed questions based on literature. Chi-square tests, t tests, and Wilcoxon rank-sum test were used to examine the differences in responses between parents in rural and urban areas. RESULTS Compared with their urban counterparts, rural parents reported a higher level of negative parenting and more limited parenting resources. Both rural and urban parents reported low availability and utilization of parenting resources as well as a great need for parenting support services. CONCLUSIONS Rural parents faced more parenting challenges and limited parenting resources compared with urban parents. Both rural and urban parents with children under three years of age reported great needs for parenting resources. These findings highlight the potential of delivering accessible, sustainable, and cost-effective parenting programs via the primary health care system for public welfare in both urban and rural areas, with more attention paid to rural parents to help them improve their parenting.
Collapse
Affiliation(s)
- Jing Han
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012 Shandong China
| | - Yinjun Hao
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012 Shandong China
| | - Naixue Cui
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012 Shandong China
| | - Zhenhui Wang
- grid.414350.70000 0004 0447 1045Department of Healthcare Insurance, Beijing Hospital, No. 1 Dongdandahua Road, Dongcheng District, Beijing, 100730 China
| | - Pingping Lyu
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012 Shandong China
| | - Lei Yue
- grid.27255.370000 0004 1761 1174School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua Xi Road, Jinan, 250012 Shandong China
| |
Collapse
|
6
|
Tadesse N, Feleke A, Chanie MG, Adamu K, Mekonen AM. Health services utilization and associated factors among fee waiver beneficiaries' in Dessie city administration, Northeast Ethiopia: a cross-sectional study design. BMC Health Serv Res 2022; 22:1544. [PMID: 36528599 PMCID: PMC9759911 DOI: 10.1186/s12913-022-08963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The fee waiver system is one of the components of the 2004 health care financing reform in Ethiopia. It is a system for granting access to health services to those who are unable to pay. The utilization health services among fee waiver beneficiaries remain low and unevenly distributed. This study aimed to assess the utilization of health services and associated factors among fee waiver beneficiaries in Dessie City, Northeast Ethiopia. METHODS A community-based cross-sectional study design was employed in Dessie City from March 23 to April 23, 2021. The study was conducted among 407 fee waiver beneficiaries. A structured, interviewer-administered questionnaire was used to collect data. Participants were selected using a simple random sampling technique. Both bi-variable and multi-variable binary logistic regressions were performed. Significant factors for the outcome variable were identified at 95% CI with a p-value < 0.05. RESULTS The overall health service utilization among fee waiver beneficiaries was found to be 62.4% (95% CI: 58.1-67.2). Being an urban resident [AOR:2.83, 95% CI:1.26-6.32], having a merchant occupation [AOR:0.20, 95% CI:0.05-0.80], having an average monthly income of 500-1000 birr [AOR:3.22, 95% CI:1.06-6.90], having a chronic disease [AOR:8.36, 95% CI:4.47-15.62], and perceiving the severity of illness as mild [AOR: 0.24, 95% CI: 0.07-0.81] were found to be statistically associated factors with health service utilization. CONCLUSIONS The fee waiver beneficiaries were not fully utilizing health services at public health facilities. Being an urban resident, being a merchant, having an average monthly income of 500-1000 birr, having a chronic disease, and perceived severity of illness were significantly associated with health service utilization. As a result, boosting income-generating strategies and urbanizing rural parts of the city may improve health service utilization among fee waiver beneficiaries.
Collapse
Affiliation(s)
- Nigusie Tadesse
- grid.467130.70000 0004 0515 5212Department of Health Systems and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amsalu Feleke
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Genetu Chanie
- grid.467130.70000 0004 0515 5212Department of Health Systems and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Kidist Adamu
- grid.467130.70000 0004 0515 5212Department of Health Systems and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asnakew Molla Mekonen
- grid.467130.70000 0004 0515 5212Department of Health Systems and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|