Determinants, challenges, and opportunities of the community-based health insurance scheme in Tigray Regional State,...

Community-based health insurance (CBHI) plays a crucial role in achieving universal health coverage. This study investigates the determinants, challenges, and opportunities related to CBHI in Tigray, Ethiopia.

A mixed-methods approach was employed. In 2020, a cross-sectional survey was conducted involving 800 rural households in Tigray, combined with semi-structured key informant and in-depth interviews. Multistage random sampling and logistic regression analyses were also applied.

Enrollment was strongly associated with having a chronic illness (AOR = 64.5, p ≤ 0.01), primarily due to a policy that permits indigents with chronic conditions to enroll without payment. Other factors included membership in a political party (AOR = 3.76, p ≤ 0.01), holding formal positions (AOR = 1.55, p = 0.03), receiving aid (AOR = 1.62, p ≤ 0.01), and membership in Edir (AOR = 1.66, p ≤ 0.01). Conversely, enrollment was negatively impacted by low trust (AOR = 0.66, p = 0.04), limited awareness (AOR = 0.4, p ≤ 0.01), poor healthcare quality (AOR = 0.51, p ≤ 0.01), bureaucracy (AOR = 0.02, p ≤ 0.01), being widowed (AOR = 0.34, p ≤ 0.01), and working as a daily laborer (AOR = 0.23, p ≤ 0.01). Key barriers included structural inefficiencies, substandard healthcare service quality, and inadequate awareness.

To facilitate equitable expansion of CBHI, it is essential to address administrative obstacles, enhance trust and awareness, and provide support to vulnerable groups, in addition to leveraging traditional risk-pooling mechanisms.