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Kaso AW, Merkeb M, Obsie GW, Zenebe GA, Agero G, Tololu AK, Hailu A. Willingness to Pay for Social Health Insurance Among Public Health Workers in Gedeo Zone, Southern Ethiopia. Health Serv Insights 2024; 17:11786329241258854. [PMID: 38854435 PMCID: PMC11162132 DOI: 10.1177/11786329241258854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/16/2024] [Indexed: 06/11/2024] Open
Abstract
In Ethiopia, Social Health Insurance (SHI) implementation was delayed repeatedly due to employees' unwillingness to pay 3% of their monthly salary and fear related to the scheme's healthcare coverage. However, provisions of comprehensive training for health workers on health insurance and inclusion of healthcare financing methods in health practitioner education curriculum make their level of willingness to pay for SHI schemes uncertain. Thus, this study aimed to assess willingness to pay for the SHI scheme and its determinant factors among Healthcare providers in the Gedeo zone. From July 1 to 15, 2022, we carried out an institution-based cross-sectional study among 430 healthcare providers recruited using a multistage sampling technique. A multivariable logistic regression model was used to determine the factors associated with willingness to pay for Social Health insurance. Adjusted odds ratio (AOR) and P values of <.05 with 95% confidence intervals (CIs) were used to declare statistical significance. Out of 73.4% (95% CI: 68.8%, 77.6%) healthcare providers willing to join the SHI program, only 47.3% (95% CI: 41.5%, 53.2%) were willing to pay for the proposed 3% premium of their monthly salary. Healthcare providers who had >10, 000 Birr monthly salary (AOR = 2.45, 95% CI: 1.14, 5.26), difficulty in paying for healthcare (AOR = 3.55, 95% CI: 1.22, 10.29), history of chronic conditions (AOR = 4.61, 95% CI: 2.41, 8.82), positive attitude (AOR = 3.16, 95% CI: 1.62, 6.18), and good knowledge of the social health insurance scheme (AOR = 2.35, 95% CI: 1.17, 4.72) were more likely to pay for the social health insurance. More than half of the healthcare providers expressed a lack of willingness to pay for the social health insurance scheme. So, the government should provide an awareness creation program on the concepts and principles of the SHI scheme to improve the willingness to pay for the scheme.
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Affiliation(s)
- Abdene Weya Kaso
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Minasse Merkeb
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Girma Worku Obsie
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Getachew Assefa Zenebe
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Gebi Agero
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Abdurehman Kalu Tololu
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Alemayehu Hailu
- Department of Global Public Health and Primary Care, Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
- Section for Global Health and Rehabilitation, Faculty of Health and Social Science, Western Norway University of Applied Sciences, Bergen, Norway
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Kaso AW, Obsie GW, Debela BG, Tololu AK, Mohammed E, Hareru HE, Sisay D, Agero G, Hailu A. Willingness to pay for Social Health Insurance and associated factors among Public Civil Servants in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0293513. [PMID: 38335220 PMCID: PMC10857707 DOI: 10.1371/journal.pone.0293513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/14/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The provision of equitable and accessible healthcare is one of the goals of universal health coverage. However, due to high out-of-pocket payments, people in the world lack sufficient health services, especially in developing countries. Thus, many low and middle-income countries introduced different prepayment mechanisms to reduce large out-of-pocket payments and overcome financial barriers to accessing health care. Though many studies were conducted on willingness to pay for social health insurance in Ethiopia, there is no aggregated data at the national level. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of willingness to pay for social health insurance and its associated factors among public servants in Ethiopia. METHOD Studies conducted before June 1, 2022, were retrieved from electronic databases (PubMed/Medline, Science Direct, African Journals Online, Google Scholar, and Web of Science) as well as from Universities' digital repositories. Data were extracted using a data extraction format prepared in Microsoft Excel and the analysis was performed using STATA 16 statistical software. The quality of the included studies was assessed using the Newcastle-Ottawa Scale for cross-sectional studies. To evaluate publication bias, a funnel plot, and Egger's regression test were utilized. The study's heterogeneity was determined using Cochrane Q test statistics and the I2 test. To determine the pooled effect size, odds ratio, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region, sample size, and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis. RESULT To estimate the pooled magnitude of willingness to pay for the Social Health insurance scheme in Ethiopia, twenty articles with a total of 8744 participants were included in the review. The pooled magnitude of willingness to pay for Social Health Insurance in Ethiopia was 49.62% (95% CI: 36.41-62.82). Monthly salary (OR = 6.52; 95% CI:3.67,11.58), having the degree and above educational status (OR = 5.52; 95%CI:4.42,7.17), large family size(OR = 3.69; 95% CI:1.10,12.36), having the difficulty of paying the bill(OR = 3.24; 95%CI: 1.51, 6.96), good quality of services(OR = 4.20; 95%CI:1.97, 8.95), having favourable attitude (OR = 5.28; 95%CI:1.45, 19.18) and awareness of social health insurance scheme (OR = 3.09;95% CI:2.12,4.48) were statistically associated with willingness to pay for Social health insurance scheme. CONCLUSIONS In this review, the magnitude of willingness to pay for Social Health insurance was low among public Civil servants in Ethiopia. Willingness to pay for Social Health Insurance was significantly associated with monthly salary, educational status, family size, the difficulty of paying medical bills, quality of healthcare services, awareness, and attitude towards the Social Health Insurance program. Hence, it's recommended to conduct awareness creation through on-the-job training about Social Health Insurance benefit packages and principles to improve the willingness to pay among public servants.
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Affiliation(s)
- Abdene Weya Kaso
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Girma Worku Obsie
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Berhanu Gidisa Debela
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Abdurehman Kalu Tololu
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Esmael Mohammed
- Bokoji Primary Hospital, Oromia Health Bureau, Bokoji, Ethiopia
| | - Habtamu Endashaw Hareru
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Daniel Sisay
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Gebi Agero
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Alemayehu Hailu
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Faculty of Health and Social Science, Section for Global Health and Rehabilitation, Western Norway University of Applied Sciences, Bergen, Norway
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Bayked EM, Toleha HN, Kebede SZ, Workneh BD, Kahissay MH. The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis. Glob Health Action 2023; 16:2189764. [PMID: 36947450 PMCID: PMC10035959 DOI: 10.1080/16549716.2023.2189764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. OBJECTIVE We evaluated the impact of Ethiopia's community-based health insurance (2012-2021) on universal health coverage. METHODS On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. RESULTS The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44-2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29-2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27-19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12-16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50-1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41-1.02). CONCLUSION Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Husien Nurahmed Toleha
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Seble Zewdu Kebede
- Department of Pharmacy, Dessie College of Health Sciences (DCHS), Dessie, Ethiopia
| | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Zarepour Z, Mebratie A, Shamebo D, Shigute Z, Alemu G, Bedi AS. Social Health Insurance and Healthcare Seeking Behavior in Urban Ethiopia. Ann Glob Health 2023; 89:84. [PMID: 38046537 PMCID: PMC10691283 DOI: 10.5334/aogh.4240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
Background After years of planning, in 2024 the government of Ethiopia proposes to introduce a compulsory Social Health Insurance (SHI) program for formal sector employees. The proposed scheme will provide access to contracted healthcare facilities at a premium of 3% of the gross monthly income of employees with another 3% coming from the employer. Objectives Several studies have examined the willingness to pay (WTP) this premium, however, little is known about the healthcare seeking behavior (HSB) of formal sector employees. This paper investigates both - the determinants of healthcare seeking behavior and among other aspects, WTP the premium. Through these explorations, the paper sheds light on the potential challenges for implementation of SHI. Methods Descriptive statistics, logit, and multinomial logit (MNL) models are used to analyze retrospective survey data (2,749 formal sector employees) which covers the major regions of the country. Findings Regarding outpatient care, a majority of the visits (55.9%) were to private healthcare providers. In the case of inpatient care, it was the opposite with a majority of healthcare seekers visiting public sector hospitals (62.5%). A majority of the sample (67%) supported the introduction of SHI but only 24% were willing to pay the proposed SHI premium. The average WTP was 1.6% of gross monthly income. Respondents in the two richest income quintiles were more likely to oppose SHI and consider it unfair. Conclusion The prominent role of the private sector and the resistance to SHI amongst the two richest income quintiles, suggests that the SHI program needs to actively include private healthcare facilities within its ambit. Additionally, concerted efforts at enhancing the quality of care available at public health facilities, both, in terms of perception and patient-centered care and addressing drug and equipment availability bottlenecks, are needed, if SHI is to garner wider support.
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Affiliation(s)
- Zahra Zarepour
- International Institute of Social Studies, Erasmus University Rotterdam, The Netherlands
| | - Anagaw Mebratie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dessalegn Shamebo
- Department of Development Economics, Ethiopian Civil Service University, Addis Ababa, Ethiopia
| | - Zemzem Shigute
- International Institute of Social Studies, Erasmus University Rotterdam, The Netherlands
- Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Alemu
- Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia
| | - Arjun S. Bedi
- International Institute of Social Studies, Erasmus University Rotterdam, Kortenaerkade 12, 2518 AX Den Haag, The Netherlands
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Bayked EM, Toleha HN, Chekole BB, Workneh BD, Kahissay MH. Willingness to pay for social health insurance in Ethiopia: A systematic review and meta-analysis. Front Public Health 2023; 11:1089019. [PMID: 37033025 PMCID: PMC10073487 DOI: 10.3389/fpubh.2023.1089019] [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: 11/07/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Background Ethiopia plans to introduce social health insurance with the aim of giving recipients high-quality, long-term universal health care. It was anticipated to be fully operational in 2014. However, due to strong opposition from public employees, the implementation has been delayed multiple times. As a result, more and more studies have been conducted to collect evidence about the issue. However, there is no national pooled evidence regarding the willingness to pay for the scheme. Thus, this review aimed to evaluate the willingness to pay for social health insurance and associated factors in Ethiopia. Methods On September 1, 2022, database searches were conducted on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Based on this search, 19 studies were included in the review. The risk of bias for the included studies was assessed using Joana Briggs Institute checklists. The data were extracted using Microsoft Excel. RevMan-5 was used to conduct the meta-analysis. The effect estimates assessed were the odds ratios at a p-value <0.05 with a 95% CI using the random effect model. Results The pooled willingness to pay for social health insurance was 42.25% and was found to be affected by sociodemographic, health and illness status, health service related factors, awareness or knowledge level, perception or attitude toward the scheme, and factors related to the scheme. The pooled result showed that the willingness of participants to pay for the scheme was 16% less likely (OR = 0.84; 95% CI: 0.52-1.36). When the outlier was unchecked, the willingness to pay became 42% less likely (OR = 0.58; 95% CI: 0.37-0.91). The lowest willingness to pay for the scheme was in the Oromia region, while the highest was in Harar. Professionally, teachers were 3.22 times more likely to pay for the scheme (OR = 3.22; 95% CI: 1.80-5.76) than health professionals. Conclusion The willingness to pay for social health insurance was low, <50%, particularly among health professionals, which urges the Ethiopian health insurance service to deeply look into the issue.
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Affiliation(s)
- Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Husien Nurahmed Toleha
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | | | - Birhanu Demeke Workneh
- Department of Pharmacy, College of Medicine and Health Sciences (CMHS), Wollo University, Dessie, Ethiopia
| | - Mesfin Haile Kahissay
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Amilaku EM, Fentaye FW, Mekonen AM, Bayked EM. Willingness to pay for social health insurance among public civil servants: A cross-sectional study in Dessie City Administration, North-East Ethiopia. Front Public Health 2022; 10:920502. [PMID: 35928482 PMCID: PMC9343680 DOI: 10.3389/fpubh.2022.920502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022] Open
Abstract
Background The readiness to pay for health insurance has an impact on universal health care. This study investigated the willingness of public civil servants in Dessie City Administration, North-East Ethiopia, to pay for social health insurance and associated factors. Methods From April to May 2021, a cross-sectional study was undertaken. The sectors from which the samples were proportionately allocated were chosen using a multistage sampling procedure. Using their payroll list as a sampling frame, simple random sampling was done to recruit them. A semi-structured self-administered questionnaire was used to collect data. Epi Data version 3.1 was used to enter, code, and clean the data, which was then exported to SPSS version 23 for analysis. To determine relationships, bi-variable and multivariable analyses were utilized. Candidates for multivariable analysis were variables with a p-value ≤ 0.3 in bi-variable analysis. AOR with a 95% CI was used to determine the strength and direction of association. Statistical significance was defined at p-value < 0.05. Results A total of 796 employees took part in the study, with a 94.42% response rate. Overall, 29.60% of them were willing to pay for the scheme (95% CI: 26.4, 33%). The decision to pay was influenced by favorable perception (AOR = 2.43, 95% CI: 1.72, 3.44), household income < Birr 5,000 (AOR = 0.26, 95% CI: 0.14, 0.48), acute illness (AOR = 0.48, 95% CI: 0.32, 0.72), bachelor level education (AOR = 0.44, 95% CI: 0.28, 0.70), master and above level education (AOR = 0.26, 95% CI: 0.14, 0.49), and age 25–29 years (AOR = 1.97, 95 % CI: 1.08, 3.57). Conclusion The willingness of the civil servants to pay for social health insurance was low, and it was influenced by their attitudes toward the scheme, the occurrence of severe illness, income level, educational status, and age.
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Affiliation(s)
| | - Fasil Walelign Fentaye
- Department of Health Systems and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asnakew Molla Mekonen
- Department of Health Systems and Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ewunetie Mekashaw Bayked
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- *Correspondence: Ewunetie Mekashaw Bayked ;
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Willingness to Pay for Social Health Insurance and Its Predictors among Government Employees in Mujja Town, Ethiopia. ScientificWorldJournal 2021; 2021:3149289. [PMID: 33746632 PMCID: PMC7952192 DOI: 10.1155/2021/3149289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/10/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Social health insurance is one of the possible organizational mechanisms for raising and pooling funds to finance health services, private health insurance, community insurance, and others. Objective The study was aimed to assess willingness to pay for social health insurance and associated factors among government employees in Mujja town, Ethiopia. Methods An institutional-based cross-sectional study was conducted on the total sample size of 375 study respondents. A simple random sampling technique was employed. Data were entered into EPI info 7 and analyzed by Statistical Package for Social Sciences version 22.0. Multivariable logistic regression was used to identify independent predictors by controlling confounding variables. Statistical significance was declared at p < 0.05. Results This study revealed that 37.6% (95% CI: 33.1%, 42.61%) respondents were willing to pay for social health insurance. In the final model, respondents who ever heard about health insurance schemes were seven times (AOR = 7.205; 95% CI: 1.385, 37.475) more likely willing to pay for social health insurance. Thos who had history of difficulty and having other source to cover medical bills were 92.6% (AOR = 0.074; 95% CI: 0.009, 0.612) and 94.6% (AOR = 0.054; 95% CI: 0.011, 0.257) less likely to pay, respectively. Conclusions Willingness to pay for social health insurance was low. Being heard about health insurance, history of difficulty, and having other sources to cover medical bills were associated factors. Thus, it is recommended that media promotion and these factors should be considered for the successful implementation of the scheme.
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Zemene A, Kebede A, Atnafu A, Gebremedhin T. Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation. Arch Public Health 2020; 78:104. [PMID: 33093953 PMCID: PMC7576701 DOI: 10.1186/s13690-020-00488-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/14/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Ethiopia is currently planning to introduce Social Health Insurance (SHI) that will lead to universal health coverage and assist a country to achieve its health system's objectives and to prevent the catastrophic health expenditure. But there is no evidence until now about the level of acceptance of the proposed SHI among government-owned companies' employees. Therefore, this study was intended to assess the acceptance of SHI and associated factors among government-owned companies' employees in northwest Ethiopia. METHODS An institution-based cross-sectional study was conducted from February 1 to April 30, 2019. A randomly selected 541 government-owned companies' employees were participated in the study. A pretested self-administered structured questionnaire was used that consisted sociodemographic and economic, health status-related factors, attitude (measured by 12 items), organizational related factors and knowledge about SHI (measured by 11 items). Finally, binary logistic regression analysis was performed and in the multivariable logistic regression analysis, a significant level at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to identify factors statistically associated with SHI acceptance. RESULTS Overall, 32% (95% CI: 27.7-36.2) of the government-owned companies' employees accepted the proposed Ethiopian SHI scheme. Self-perceived health status (AOR: 8.55, 95% CI: 2.69-27.13), heard about SHI (AOR: 1.69, 95% CI: 1.12-2.54), coverage of medical healthcare cost (AOR: 0.60, 95% CI: 0.39-0.92), work experience (AOR: 0.49, 95% CI: 0.26-0.89) and quality of healthcare service at the facilities (AOR: 0.17, 95% CI: 0.04-0.71) were significantly associated with acceptance of SHI among government-owned companies' employees. CONCLUSIONS One-third of the study participants accepted the proposed Ethiopian SHI scheme. Self-perceived health status, quality of healthcare service at health facilities, coverage of the medical cost by their organization, heard about SHI and work experience were the factors that affect acceptance of the proposed SHI among the government-owned company employees. Therefore, policymakers should devise a plan to promote the benefit packages of SHI for the formal sector employees to start the implementation.
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Affiliation(s)
- Abuneh Zemene
- University of Gondar Student Clinic, University of Gondar, Gondar, Ethiopia
| | - Adane Kebede
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Gondar, Ethiopia
| | - Tsegaye Gebremedhin
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Gondar, Ethiopia
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