Willingness to Renew Community Based Health Insurance Membership and Associated Factors in Maraka woreda, Dawuro zone, South-west Regional State, Ethiopia

Abstract

Background: Although potential instrument to achieve Universal Health Coverage, Community Based Health Insurance schemes commonly suffer from low membership renewal, which threatens the schemes’ sustainability in many developing countries. Hence, this study investigated the willingness to renew Community Based Health Insurance membership and associated factors among enrolled households in Maraka woreda, Dawuro zone. Objective: To assess willingness to renew Community Based Health Insurance membership and associated factors in Maraka woreda, Dawuro zone. Methodology: Community based cross-sectional mixed methods design with sequential explanatory qualitative methods was employed. Using multi-stage random sampling, 5 kebeles were included in the study, from which 693 enrolled households were selected through systematic random sampling (k=5). Descriptive, bivariate, and multivariate logistic regression analyses of data was done using SPSS version 25 software, with statistical significance considered at P-value <0.05. Qualitative data were collected through focus group discussions and key informant interviews, with samples selected using maximum-variation methods. The obtained data were coded and thematically analyzed using ATLAS.ti 9 software. Results: Willingness to renew Community Based Health Insurance membership was shown to be 79.1%. Presence of chronic illness (AOR = 0.30; CI: 0.18-0.52), proportion of household members with poor self-rated health status (AOR = 2.01; CI: 1.04-3.72), recent hospitalization history (AOR = 0.2; CI: 0.11-0.35), perceived availability of medications (AOR = 2.52; CI: 1.48-4.29), premium affordability (AOR = 2.2, CI: 1.26-4.79), perceived benefit packages adequacy (AOR = 2.90; CI: 1.76-4.79), enrollment duration (AOR = 4.01; CI: 2.12-7.56), and participation in scheme related meetings (AOR = 2.40; CI: 1.27-4.58) were predictors shown to be significantly associated with members’ willingness to renew membership. Conclusion: Magnitude of willingness to renew Community Based Health Insurance membership in the woreda was shown to be relatively lower than the woreda’s renewal target for 2016 E.C. Therefore, increased scheme transparency and community engagement, along with policy interventions involving differential premium pricing based on ability to pay and upgrading of the current scheme design to a larger regional or federal pool are recommended to increase members’ desire to renew membership.