Process evaluation of community-based health insurance program in Damboya Woreda, Kembata Tembaro Zone, Southern Nations, Nationalities & Peoples’ Regional State

Abstract

Background: In the developing countries, ensuring health service equity is difficult. The limited government capacity to cover health care costs and high out-of-pocket expenditure made it challenging. Even though cost of avoiding health service inequity is high, it is compulsory to assure health care equity for all; for health is fundamental human right. As a result, Ethiopian government endorsed Community Based Health Insurance Strategy in 2008. Nation wide, its implementation was piloted in 13 Woredas’ in 2011; the study area was one of piloted Woredas’; i.e. it is capable to generate adequate evidence for the evaluation. Even if it has been implemented yet, to my best knowledge its implementation process is unknown. Objective: To assess the process of community based health insurance program implementation in Damboya Woreda, Kembata Tembaro Zone, South Nations Nationalities peoples’ Region. Methods: A single case study design with mixed data collection methods was employed from March 16 to May 16/2020 with availability, compliance and satisfaction as an evaluation dimensions. A total of 610 households survey via multi-stage sampling and 16 key informant interviews were conducted by using structured questionnaire and Key informant interview guide respectively. Also a resource inventory and relevant documents of the program were reviewed by using standard checklists. Finally, quantitative data were entered into Epidata 3.1 and analyzed by SPSS 25. Logistics regression was used to identify factors associated with member satisfaction. Qualitative data were transcribed, translated, coded, and categorized into families by using ATLAsi.ti.7.1.4.; finally analyzed under five themes. Results: The resources availability for program implementation, program activities compliance with regional standards and house holds satisfaction towards the scheme scores were 85 %, 62 % and 56% respectively; where educational level, getting laboratory service, explaining the service being provided, assessing the health problem, distance from the contacted health facility and need for service provision improvement were major barriers for program implementation. Conclusion: The overall implementation level of the program was 67%; which is partial as per judgement parameter. The due concern by scheme for improving activities like: clinical audit, reimbursing, supportive supervision and feedbacks provision as well availing service registers.