The interaction of healthcare service quality and community-based health insurance in Ethiopia

Knowledge, Practice and Associated Factor of Trachoma Transmission and Prevention Among Primary School Students in Addis Zemen Town, South Gondar, Northwest Ethiopia

Background

Trachoma is the leading infectious cause of blindness worldwide, particularly impacting the poorest nations, including Ethiopia.

Objective

To assess knowledge, practice, and associated factors of trachoma transmission and prevention among primary school students in Addis Zemen town, South Gondar, Northwest Ethiopia, 2022.

Methods

An institution-based cross-sectional study was conducted on 407 randomly selected primary school students (grades 5-8), aged 10 to 24 years. Data collection included face-to-face interviews using structured questionnaires and an observation checklist. Epi-data version 4.2.0.0 and SPSS version 20 were used to enter and analyze the collected data, respectively. The data were analyzed using the descriptive statistical method and using bivariable and multivariable logistic regression models. Variables with a P-value <.05 with a 95% CI were considered to have statistical significance.

Result

The study has a response rate of 98.25%, with a total of 400 respondents. 74.00% of the respondents knew about trachoma transmission and prevention, and 71.50% practiced preventive measures, such as face washing. Respondents in Grades 7 and 8, aged 12 to 24 years (AOR: 2.67, 95% CI: 1.93, 4.64), information about trachoma (AOR: 2.30, 95% CI: 1.56, 4.21), and urban residence (AOR: 3.42, 95% CI: 2.56, 5.23) were determinants of knowledge regarding trachoma transmission and prevention. Meanwhile, the mother's occupation (government employee) (AOR: 2.50, 95% CI: 1.83, 6.91) and overall knowledge about trachoma (AOR: 4.87, 95% CI: 2.95, 8.53) were significant predictors of the practice of trachoma transmission prevention.

Conclusion

While the level of knowledge and practice regarding trachoma transmission and prevention was relatively high, 26.00% of respondents still lacked adequate knowledge, and 28.50% did not practice prevention measures. To reduce the spread of trachoma and enhance public health outcomes, targeted interventions focusing on education about transmission and prevention strategies such as promoting face washing and proper sanitation should be prioritized in this area.

Beneficiaries' satisfaction with community-based health insurance services and associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

The viability of community-based health insurance programs depends on beneficiary satisfaction, and healthcare systems evaluate performance through patient reports and ratings to ensure effectiveness and service quality. To our knowledge, Ethiopia lacks national pooled data on the satisfaction of community-based health insurance beneficiaries and related factors. As a result, this review aimed to evaluate the level of beneficiaries' satisfaction with the scheme's services and associated factors in Ethiopia.

METHODS

Database searches on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar were conducted on September 1st, 2022. Thirteen studies were chosen for review from the search results. Checklists from the Joan Briggs Institute were used to evaluate the risk of bias for the included studies. The data were extracted using a 2019 Microsoft Excel spreadsheet and analyzed using Stata 17. The odds ratios at p-values less than 0.05 with a 95% confidence interval were used to evaluate the effect estimates.

RESULTS

The pooled satisfaction of beneficiaries with community-based health insurance was found to be 66.0% (95% CI = 57-76%) and was found to be influenced by socio-demographic, health service-related, the scheme's related factors, and the beneficiaries' knowledge of it. The beneficiary satisfaction levels were highest in the Amhara region, at 69.0% (95% CI = 59-79%), followed by Southern Nations Nationalities and Peoples' Region (SNNPR) at 67.0% (95% CI = 40-94%), Oromia at 63.0% (95% CI = 58-68%), and Addis Ababa at 53.0% (95% CI = 45-62%).

CONCLUSION

Even though there was a moderate level of satisfaction, there are indications that the quality of health services and the coverage of the entire population lag behind, necessitating greater efforts to achieve universal health coverage.

Enrollment and clients' satisfaction with a community-based health insurance scheme: a community-based survey in Northwest Ethiopia

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.

The path to universal health coverage in five African and Asian countries: examining the association between insurance status and health-care use

Despite major efforts to achieve universal health coverage (UHC), progress has lagged in many African and Asian countries. A key strategy pursued by many countries is the use of health insurance to increase access and affordability. However, evidence on insurance coverage and on the association between insurance and UHC is mixed. We analysed nationally representative cross-sectional data collected between 2022 and 2023 in Ethiopia, Kenya, South Africa, India, and Laos. We described public and private insurance coverage by sociodemographic factors and used logistic regression to examine the associations between insurance status and seven health-care use outcomes. Health insurance coverage ranged from 25% in India to 100% in Laos. The share of private insurance ranged from 1% in Ethiopia to 13% in South Africa. Relative to the population with private insurance, the uninsured population had reduced odds of health-care use (adjusted odds ratio 0·68, 95% CI 0·50-0·94), cardiovascular examinations (0·63, 0·47-0·85), eye and dental examinations (0·54, 0·42-0·70), and ability to get or afford care (0·64, 0·48-0·86); private insurance was not associated with unmet need, mental health care, and cancer screening. Relative to private insurance, public insurance was associated with reduced odds of health-care use (0·60, 0·43-0·82), mental health care (0·50, 0·31-0·80), cardiovascular examinations (0·62, 0·46-0·84), and eye and dental examinations (0·50, 0·38-0·65). Results were highly heterogeneous across countries. Public health insurance appears to be only weakly associated with access to health services in the countries studied. Further research is needed to improve understanding of these associations and to identify the most effective financing strategies to achieve UHC.

The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis

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.

Dropout rate and associated factors of community-based health insurance beneficiaries in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Ethiopia aims to achieve universal healthcare using health insurance. To do so, it has been implementing community-based health insurance since 2011. However, the retention of members by the scheme has not yet been evaluated nationally. The systematic review and meta-analysis aimed to evaluate the dropout rate and associated factors among the scheme's beneficiaries in Ethiopia.

METHODS

On December 19, 2022, searches were conducted in Scopus, Hinari, PubMed, Semantic Scholar, and Google Scholar. Searches were also conducted on the general web and electronic repositories, including the Ethiopian Health Insurance Service, the International Institute for Primary Health Care-Ethiopia, and various higher education institutions. The Joanna Briggs Institute's tools and the "preferred reporting items for systematic reviews and meta-analyses 2020 statement" were used to evaluate bias and frame the review, respectively. Data were analyzed using Stata 17 and RevMan 5. To assess heterogeneity, we conducted subgroup analysis and used a random model to calculate odds ratios with a p value less than 0.05 and a 95% CI.

RESULTS

In total, 14 articles were included in the qualitative synthesis, of which 12 were selected for the quantitative analysis. The pooled estimate revealed that the dropout rate of beneficiaries from the scheme was 34.0% (95% CI: 23-44%), provided that the renewal rate was 66.0%, and was found to be influenced by socio-demographic, health status, length of enrolment, knowledge, attitude, the scheme, and health service-related variables. The southern and Oromia regions reported the lowest and highest dropout rates, with 27.0% (95% CI: 24-29%) and 48.0% (95% CI: 18-78%), respectively. The dropout rates increased from 12.3% in 2012-2015 to 34.4% in 2020-2021.

CONCLUSION

More than one-third of the scheme's beneficiaries were found to have dropped out, and this has been found to increase over time, dictating that a community-based strategy and intervention, from the supply, insurer, and demand sides, seem indispensable in minimizing this huge dropout rate.

Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers

OBJECTIVES

This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates.

DESIGN

One of the aims of our National Institute for Health Research global health research group 'Achieving Control of Asthma in Children in Africa' was to use qualitative thematic analysis of transcribed audio recordings from focus group discussions (FGDs) to describe barriers to achieving good asthma control.

SETTING

Schools in Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda) and Harare (Zimbabwe).

PARTICIPANTS

Children (n=136), 12-14 years with either asthma symptoms or a diagnosis and their caregivers participated in 39 FGDs. All were recruited using asthma control questions from the Global Asthma Network survey.

RESULTS

There were four key themes identified: (1) Poor understanding, (2) difficulties experienced with being diagnosed, (3) challenges with caring for children experiencing an acute asthma episode and (4) suboptimal uptake and use of prescribed medicines. An inadequate understanding of environmental triggers, a hesitancy in using metred dose inhalers and a preference for oral and alternate medications were identified as barriers. In addition, limited access to healthcare with delays in diagnosis and an inability to cope with expected lifestyle changes was reported. Based on these findings, we recommend tailored education to promote access to and acceptance of metred dose inhalers, including advocating for access to a single therapeutic, preventative and treatment option. Furthermore, healthcare systems should have simpler diagnostic pathways and easier emergency access for asthma.

CONCLUSIONS

In a continent with rapidly increasing levels of poorly controlled asthma, we identified multiple barriers to achieving good asthma control along the trajectory of care. Exploration of these barriers reveals several generalisable recommendations that should modify asthma care plans and potentially transform asthma care in Africa.

TRIAL REGISTRATION NUMBER

269211.

Community-Based Health Insurance Utilization and Its Determinants among Informal Workers: Cross-Sectional Study

Background

Ethiopia has implemented a community-based health insurance (CBHI) program to provide coverage to 80% of the population and shield underprivileged individuals from the detrimental effects of exorbitant medical expenses. However, there is a paucity of data regarding its utilization and pertinent concerns. This study aimed to evaluate the utilization of CBHI and its associated factors among informal workers in Berek District.

Methods

This community-based cross-sectional study was conducted between June 15 and July 15, 2022. The sample population comprised 538 households selected using a multistage sampling approach. Data analysis was done using SPSS Version 26. Variables with P-values of less than 0.25 during the bivariate analysis were selected for multivariate analysis using binary logistic regression. The statistical significance threshold was set at a p-value of 0.05.

Results

The utilization of Community-Based Health Insurance (CBHI) was 49.8%. Age between 30 and 39 years, monthly earnings of less than 1500 Ethiopian Birr, presence of chronic illness, membership in social organization, and possessing adequate knowledge were found to have a statistically significant association with the use of CBHI.

Conclusion

The utilization of CBHI was low within the confines of this district Age, income, social group membership, and chronic illnesses were significantly associated with CBHI utilization.

Satisfaction of beneficiaries with community-based health insurance and associated factors in Legambo District, North-East Ethiopia: a cross-sectional study

Background

The fundamental concept of community-based health insurance is to strengthen the healthcare financing system to access universal healthcare by reducing costly risk-coping strategies. The scheme's sustainability and the quality of services provided by it are highly dependent on the satisfaction of its beneficiaries. Despite beneficiaries' satisfaction being the key determinant for providing evidence for policy revision and decision-making, it has often been neglected. Therefore, the study investigated the community-based health insurance beneficiaries' satisfaction and associated factors in Legambo district, North-East Ethiopia.

Methods

The study was conducted in the Legambo district with a community-based cross-sectional study design from October to November 2019. The data were collected from 838 households that had been the beneficiaries of the scheme using multi-stage and systematic random sampling. Twelve trained data collectors were employed and gathered the data using a pre-tested, structured questionnaire. We ran descriptive, bivariate, and logistic regression analyses. A value of p less than 0.05 with a 95% CI was used in multivariate logistic regression to determine the association of variables with the beneficiaries' satisfaction.

Results

The overall satisfaction level of the beneficiaries of the scheme was 58.6% and was associated with the following factors: merchandize (AOR = 1.92, 95% CI = 1.02-3.63), living in rural areas (AOR = 1.52, 95% CI = 1.02-2.27), an early office opening time (AOR = 3.81, 95% CI = 2.04-7.10), a short time interval to use benefit packages (AOR = 4.85, 95% CI = 2.08-11.31), an inexpensive membership premium (AOR =10.58, 95% CI = 3.56-31.44), availability of laboratory services (AOR =2.95, 95% CI = 1.71-5.09), presence of referral services (AOR =1.93, 95% CI = 1.33-2.80), having immediate care at health facilities (AOR = 1.73, 95% CI = 1.01-2.97) and non-compulsory enrolment (AOR = 6.31, 95% CI = 1.64-24.20).

Conclusion

The beneficiaries' satisfaction with the scheme was suboptimal and found to be determined by occupation, residence, laboratory and referral services, immediate care, office opening time, time interval to use benefit packages, premium amount, and situation of enrollment, most of which are service-related variables. Thus, to improve the satisfaction level, the stakeholders that should work hard seem to be the health insurance agency (the insurer) and the health facilities (the provider or supplier).

Perceived quality of care among households ever enrolled in a community-based health insurance scheme in two districts of northeast Ethiopia: a community-based, cross-sectional study

OBJECTIVES

To examine how clients perceived the quality of healthcare they received and identify associated factors both at the individual and facility levels.

DESIGN

A community-based, cross-sectional study.

SETTING

Two rural districts of northeast Ethiopia, Tehulederie and Kallu.

PARTICIPANTS

1081 rural households who had ever been enrolled in community-based health insurance and visited a health centre at least once in the previous 12 months. Furthermore, 194 healthcare providers participated in the study to provide cluster-level data.

OUTCOME MEASURES

The outcome variable of interest was the perceived quality of care, which was measured using a 17-item scale. Respondents were asked to rate the degree to which they agreed on 5-point response items relating to their experiences with healthcare in the outpatient departments of nearby health centres. A multilevel linear regression analysis was used to identify predictors of perceived quality of care.

RESULTS

The mean perceived quality of care was 70.28 (SD=8.39). Five dimensions of perceived quality of care were extracted from the factor analysis, with the patient-provider communication dimension having the highest mean score (M=77.84, SD=10.12), and information provision having the lowest (M=64.67, SD=13.87). Wealth status, current insurance status, perceived health status, presence of chronic illness and time to a recent health centre visit were individual-level variables that showed a significant association with the outcome variable. At the cluster level, the work experience of healthcare providers, patient volume and an interaction term between patient volume and staff job satisfaction also showed a significant association.

CONCLUSIONS

Much work remains to improve the quality of care, especially on information provision and access to care quality dimensions. A range of individual-level and cluster-level characteristics influence the perceived quality of care. For a better quality of care, it is vital to optimise the patient-provider ratio and enhance staff job satisfaction.

Perceptions towards childhood asthma and barriers to its management among patients, caregivers and healthcare providers: a qualitative study from Ethiopia

Background

The management of asthma, which is one of the major causes of childhood morbidity and mortality has been affected by non-adherence to recommended treatment regimens with severe consequences. The aim of the present study was therefore to explore the perceptions of the children with asthma, their caregivers and their healthcare providers towards asthma and barriers to long term childhood asthma management in an institutional setting in Addis Ababa, Ethiopia.

Methods

A qualitative descriptive design was followed for the present study that used individual interviews as a data collection method. The study participants were 23 pairs of children with asthma that had treatment follow-ups in two tertiary hospitals and their caregivers and eight healthcare providers who cared for these children. The data was analyzed using thematic analysis approach.

Results

The study findings revealed that the children’s reported adherence to the recommended treatment regimens was low and they along with their caregivers were facing physical, emotional and social burdens related to asthma. Some of the influencing factors affecting childhood asthma management were found to be the low-level implementation of the asthma management guidelines by the healthcare providers, limited awareness about asthma and its management by the children and their caregivers, use of traditional home remedies and religious healing on a complementary and alternative basis and inadequate education received from healthcare professionals. Further identified barriers to the adherence of especially inhaled corticosteroids appear to be the low necessity beliefs towards chronic administration of treatment regimens and concerns related with difficulty of administration, fear of side effects and general negative attitude towards it, in addition to their low availability and affordability.

Conclusions

Low awareness of the biomedical treatment regimens and use of traditional home remedies and religious healing by the children with asthma and their caregivers, the low-level implementation of the asthma management guidelines as well as low access to medications may among other things contribute to the low adherence of the children to their recommended regimens. The findings support the need for implementation of asthma management guidelines, institution of strong asthma care and education programs that are sensitive to local and individual patients’ and caregiver perceptions and experiences including emotional distress, the need to institute chronic care approach and ways to address patients’ medication access issues.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01984-2.