Essays on evaluating a community based health insurance scheme in rural Ethiopia

Abstract

Since the late 1990s, in a move away from user fees for health care and with the aim of creating universal access, several low and middle income countries have set up community-based health insurance (CBHI) schemes. Following this approach, in June 2011, with the aim of enhancing access to health care and reducing the burden of out-of-pocket health care expenditure, the Government of Ethiopia rolled out a pilot CBHI scheme. The scheme caters to rural households and urban informal sector workers in 13 districts located in four main regions (Tigray, Amhara, Oromiya, and SNNP) of the country. The main aims of this thesis are to assess the factors that drive initial scheme uptake and contract renewal and to identify the impact of CBHI on utilization of care and financial protection. As a prelude to an assessment of these issues, the thesis also provides a systematic review of the literature on CBHI schemes and uses five clinical vignettes to assess the demand for modern health care in rural Ethiopia. The thesis uses data obtained from various sources: three waves of a household panel survey, a health facility survey and qualitative information gathered through focus group discussions and key informant interviews.