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Background: Health insurance system is one of the means to enhance access to health care services and to protect individuals from catastrophic health expenditures. Social marketing strategies such as radio, television, print media, facility &community based sensitizations have been used to augment enrollment in to community-based health insurance (CBHI) schemes in Ethiopia. However, there is gap of evidence on the influence of existing social marketing strategies on CBHI enrollment in Ethiopia. Objectives: This study aims to assess the effect of utilization of social marketing strategies on households to join CBHI and associated factors with enrollment in Lideta Sub City, Addis Ababa. Methods: A cross sectional study was conducted among a sample of 422 randomly selected households of Lideta sub-city, Addis Ababa in two randomly selected woredas using structured questionnaires. Epi-data version-3.1 and SPSS version-25 were used for data entry and analysis respectively. Descriptive statistics were used and data were presented using tables and figures. A binary & multiple logistic regression models were used to determine the odds of enrollment for each predictor. The investigator obtained ethical clearance from Addis Ababa University ethical review committee. Results: The level of utilization of social marketing strategies for CBHI among households was 75.6% (69% enrolled and 31% not enrolled) with level of utilization of house to house sensitization (18.9%), local radio (11.1%), national radio (8.3%), and health facility based sensitization (5.7%). The most motivator of the households to join CBHI was house to house sensitization (37.81%). Multivariate Logistic regression revealed no significant association between social marketing strategies and enrollment, but only house hold income (AOR = 0.023, 95% CI; 0.006–0.092, p<0.001) and family size (household with ≥ 4 members) (AOR = 10.99, 95% CI; 3.19–37.83, p<0.001) were significant factors associated with enrollment. Conclusion and recommendations: In this study, the overall level of utilization of existing social marketing strategies was high but not significantly associated with households CBHI enrollment. Family size and average monthly income of households were significant determinants of enrollment and also most members were enrolled after being sick, indicating that sensitization at the health facility by health service providers was the common social marketing strategy. Thus, the study indicated evidence of adverse selections. The government may need to look for options to make the CBHI scheme contribution based on the economic status of households and compulsory. |
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