Determinants of enrolment for community-based health insurance in Somali region of Ethiopia.

Background: Community-based health insurance (CBHI) is a type of health insurance programme that provides financial protection against the cost of illnesses and improves access to healthcare services for communities in the informal sector.

Aim: The aim was to assess the determinants of enrolment for CBHI in Aw-barre district - an agro-pastoral setting in the Somali region, Ethiopia.

Setting: Ethiopia launched the CBHI scheme in 2011 as part of the revised healthcare financing strategy to realise universal health coverage. It was then scaled up in the rural part of the country in 2013, except the pastoralist regions including the Somali region which started as late as 2020.

Methods: A community-based, unmatched case-control study was conducted using a concurrent nested approach between March 2021 and April 2021, among 214 participants (54 enrolled and 160 non-enrolled). Quantitative data were analysed using SPSS version 20, and thematic analysis was performed for the qualitative data.

Results: Awareness of the CBHI scheme adjusted odds ratio (AOR) = 9.67 (1.26, 74.53), household income AOR = 3.56 (1.03, 12.30) and being a member of community-based solidarity groups AOR = 2.48 (1.17, 5.26) were the determinants for CBHI enrolment and were reaffirmed by the qualitative findings.

Conclusion: Increasing community awareness of the scheme via various platforms is essential. Leveraging community-based solidarity associations, and social protection platforms would help increase enrolment.

Contribution: Given the distinct sociodemographic, economic and geographic peculiarities of agro-pastoralists, the CBHI parameters and implementation strategies must be tailored to the setting before scaling it up.