Knowledge, Attitudes and Practices Regarding

Community-Based Health Insurance in

Dembecha Town, Ethiopia, 2014: A Cross-

Sectional Design

By Xiuzhe (Ally) Mai

Touro University – California, 2015

Professor Sahai Burrowes, Faculty Advisor

Date: April 23rd, 20151

Background

• High out-of-pocket household

health expenditure;

• Lack of access;

• Low utilization of health;

services;

• Free health care:

• for the informal sector

• 88% of the total population2

Research Questions

What is/are:1. Current level of enrollment and

utilization;2. Percentage of households with

sufficient knowledge or favorable attitude;

3. Demographic and socio-economic factors;

4. The association between knowledge, attitudes, and practices (KAP) of CBHI? 3

Problem Statement

1.Lack of studies on the association between health literacy and health behavior;

2.Existing studies mostly focused on scheme uptake and acceptable price range across Ethiopia.

3.This study will also provide evidence for program evaluation, monitoring, and implantation.

4

Literature Review

• Overall high acceptance and strong WTJ (willingness to join): • 60% -78% WTJ and 5-10 ETB per month

(Asfaw & Braun, 2004; Abay et al., 2005; Ololo, Jirra, Hailemichael & Girma, 2009; Haile, Ololo & Megersa, 2014).

• Rapid enrollment rate: 46% in 2012;• Positive impact:

• A 13% reduction in indebtedness and • an 1087 ETB ($54 USD) increase of annual

income, • 35% lower risk of mortality with shorter distance

to health facility, and • 37% lower risk of mortality with higher

education (Derseh et al., 2013).

5

Methods• Cross-sectional study: secondary data from DMU

• Study locations: 2 urban Kebeles (villages) of Dembecha Woreda (town)

• 95% response rate & random sampling• Exclusion: < 18 years old & not permanent

resident

• Study Variables:• Outcome & explanatory variables

• Additive Indexes of KAP: • From 3 sets of questions about KAP;• Mean value as cut-off point for K/A;

• Practice=enrollment. 6

Methods

1. Data analysis:• Descriptive statistics• Pearson Chi Square tests• Multivariate linear

regression • Multivariate logistic

regression2. Diagnostic tests:

• Histograms & normal distribution

• Multi-collinearity 7

83 72

16

1728

84

Level of Knowledge, Attitude, and Practice

Top: PoorBottom: Good

Perc

enta

ge (%

)Result

8

Lack o

f mon

ey

Not en

ough

info

abou

t CBHI

I don

’t th

ink C

BHI is i

mporta

nt

Lack o

f und

erstan

ding

Possib

le co

rrupt

ion

Other

0%

10%

20%

30%

40%

50%

60%

70%

80%

27%

70%

11% 13%3% 6%

Reasons of Non-Participation in CBHI

Result

Each reason was a dichotomous question, so the percentages do not add up to 100%.

9

The health facil-ity doesn't pro-vide needed ser-

vices49%

Members did not completely pay all related fees

37%

Others14%

Reasons of not using CBHI among members

Result

10

Determinants of Knowledge of CBHI

N=311R2= 27%

11

Determinants of Attitudes Towards CBHI

N=311R2= 29%

12

Level of Practices of CBHI

N=311R2= 28%

13

Discussion

The majority of participants had:

• sufficient knowledge & favorable attitude

• Low enrollment (16%)

• Indigents (10%)

• The national level (46%)

• The Amhara regional enrollment rate (63%) (Mebratie et al., 2014b).

• The low enrollment rate:• The lack of knowledge and unaffordability.

14

Discussion

• The WTJ is 70% among non-members;• Utilization of CBHI is modest;• The under-utilization:

• The poor quality of care and unaffordability.

15

Implications

1. Discrepancy of knowledge;

2. Poor info dissemination;

3. Poor documentation;

4. Attitude isn’t a significant

predictor in behavior (LaPiere,

1934)

• Attitude predicts general

behavior, not specific ones.

16

Study Limitations

1.The study population only focused on

urban kebeles

• not generalizable to rural areas.

2.Lack of qualitative data & similar studies;

3.Survey design: professional jargon and

concepts, social desirability bias;

4.Missing data;

5.Regional differences: climate, geography,

ethnicity, religion, etc.17

Recommendations1.Future research: qualitative studies

2. Information dissemination:• Additional channels• Content change • New strategy: Members’

testimonials3. Incorporation into the Health

Extension Program (HEP)

4. Flexible payment collection schedule: • bi-monthly, quarterly, monthly,

annually 18

Thank you! Questions? 19