Community based health insurance practice enrollment and challenges in ethiopia case of oromiya regional state rural community of aleltu district’’

ADDIS ABABA UNIVERSITY COLLEGE OF BUSINESS AND ECONOMICS SCHOOL OF POST GRADUATE DEPARTMENT OF PUBLIC ADMINISTRATION AND DEVELOPMENT MANAGEMENT (PADM) “COMMUNITY BASED HEALTH INSURANCE PRACTICE/ENROLLMENT AND CHALLENGES IN ETHIOPIA CASE OF OROMIYA REGIONAL STATE RURAL COMMUNITY OF ALELTU DISTRICT’’ By: Gutema Namomsa Advisor: Bikila Hurisa (Ph D) June 2017 Addis Ababa, Ethiopia Addis Ababa University School of Graduate Studies College of Business and Economics Department of Public Administration and Development Management “COMMUNITY-BASED HEALTH INSURANCE PRACTICE/ENROLLMENT AND CHALLENGES IN ETHIOPIA CASE OF OROMIYA REGIONAL STATE RURAL COMMUNITY OF ALELTU DISTRICT’’ A thesis submitted to the Department of Public Administration and Development Management of Addis Ababa University in the partial fulfillment of the requirement for the Masters of the Public Management and Policy (MPMP) By: Gutema Namomsa Advisor: Bikila Hurisa (Ph.D) June 2017 Addis Ababa, Ethiopia Addis Ababa University School of Graduate Studies College of Business and Economics Department of Public Administration and Development Management This is to certify that the thesis prepared by Gutema Namomsa entitled “Community-Based Health Insurance Practice/Enrollment & Challenges in Ethiopia: Case of Ormiya Regional State; Rural Community of Aleltu District’’ Which is submitted in partial fulfillment of the requirements for the Degree of Public Management andPolicy (MPMP), complies with the regulations of the University and meets the acceptedstandards with respect to standards to originality and quality? Approved by Board of Examiners: _ Advisor _ Internal Examiner External Examiner _ Signature Signature _ Signature Date Date _ Date Declaration I declare that this Research Report on “Community-based health insurance practice/enrollment & challenges in Ethiopia: case of Oromiya regional state; rural community of Aleltu district’’ Is my own original work with assistances and guidance from my Advisor and not submitted before for any institution and any purpose I further declare that all the sources used in this research report have been properly recognized and acknowledged as intext-citation and reference list Gutema Namomsa Daraje _ Signature Date Acknowledgment First & for most I owe my heartedly thanks to almighty God, the merciful and compassionate, for helping me to carry the entire burden via my study & research conduct My heartfelt gratitude goes to my families (Especially My dad Mr Namomsa D Keba& My Mam Kebebush Bayisa as well as my sisters Alganesh, Aster & Mimi) for their infinite support in my study journey) My especial thanks go to my thesis advisor Bikila Hurisa (Ph D) whose kind support, insight & guidance have turned the whole process of this study endeavor full of learning and enjoyable I would also like to thank to the employees and management of EHIA & district office who cooperate with me by filling honest interview that provide valuable information for conducting & completing this study Finally, yet important, special thanks go to Mr Demise (CBHI Finfine branch manager) Mr Kidane Irana (Team leader of Aleltu CBHI) i Dedication I would like to dedicate this thesis to my grandfather Mr Bayisa Bekere His role in my life (especially) in my academic life is very significant I can’t express his role within one page of paper, I know my grandfather ‘’Akakeyu’’ without your constructive advice I will not reach this stage your special model So my lovably grandfather when I decide to dedicate my thesis work to you it is without any doubt hence I love you & RIP Ermiyas Namomsa ii Table of content Page Acknowledgment i Dedication ii Table of content iii List of table vi List of Figure vi Acronyms x Abstract xi CHAPTER ONE 1.INTRODUCTION & BACKGROUD OF THE STUDY 1.1.Introduction 1.1.1.Ethiopian Health Insurance Agency 1.2.Statement Of The problem 1.3.Objectives of The study 1.3.1.General research Objectives 1.3.2.Specific research Objectives 1.4.Research question 1.5.Significance of the study 1.6.Scope of the Study 1.7.Limitation of the study 2.Literature Review 2.1 Concept of Community Based Health Insurance 2.2 Weakens of Community Based Insurance 12 2.3 Types of Community Based Health Insurance 12 iii 2.3.1 Community prepayment health organizations 15 2.3.2 Provider based health insurance schemes 15 2.3.3 Government runs community-involved health insurance 15 2.4 Community Based Health Insurance in Developing country 16 2.5 Community Participation 19 2.6 Empirical findings concerning the performance/enrollment of CHIs 20 2.6.1 Performance criteria 20 2.6.2 Exploring factors that influence performance 21 2.6.2.1 Factors influencing membership 21 2.7 Health Sector in Ethiopia 23 2.7.1 Community Based Health Insurance in Ethiopia 25 2.7.1.1 Knowledge, Enrollment, and Affordability 29 2.7.1.2 Major Challenges in quality services provided 30 2.7.1.3 Mobilizing Additional Resources to Health Providers 30 2.7.1.4 Remove Overall Health Systems Constraints 32 2.7.2 Enrollment & significance of CBHI in Ethiopia 32 3.Research Methodology & Methods 39 3.1 Research Design 39 3.2 Study & sample population 40 3.3 Sample Design 40 3.3.1 Sample & Sample size determination 40 3.3.2 Sampling Techniques 41 3.4 Types of data and data collection Technique 42 3.4.1 Types of data 42 3.4 Primary data collection Technique 42 iv 3.5 Secondary data collection Method 43 3.5.1 Data Analysis Methods 43 3.6 Data Presentation Modality 44 3.7 Ethical Consideration 44 Data Presentation and Analysis 46 4.1 Introduction 46 4.2 Background of the respondents 46 4.3 Beneficiaries (insured household‟s) response on CBHI 53 4.3.1 Awareness level of Community on the concept of Community based health insurance 53 4.3.2 Households health status & income impact on the CBHI 62 4.3.3 CBH, its challenges & benefits 66 4.3.4 Participation in CBHI programs 84 4.4 Discussion of the result 87 4.4.1 Practice/enrollment of Community based health insurance 87 4.4.2 Challenges faced on enrolling the Community based health insurance 88 4.4.3 Major benefit the society is getting from enrolling in CBHI 89 Conclusion & Recommendation 90 5.1 Introduction 90 5.2 Conclusion 90 5.3 Recommendation 92 Bibliography 94 Annexes 96 v List of table Page Table 2.1: Features of different CBHI models……………………………………………….13 Table 2.2: List of pilot and control woreda‟s………………………………………………… 27 Table 2.3 Projected Annual Financial Implications of CBHI Scale-up to Federal, Regional, and Woreda Governments ('000 Birr)……………………………….31 Table 2.4 Major Parameters of Ethiopian CBHI Pilot Schemes…………………………………34 Table 3.1 shows the population & sample selection of the study………………………………42 Table 3.2 Profile of the officials (employees)…………………………………………………42 Table 4.1: Beneficiaries Age related distribution………………………………………….……47 Table 4.2: Martial status of the respondents…………………………………………… ….49 Table 4.3: Occupational status of the respondents……………………………………….….51 Table 4.4: Number of children‟s >=18 &