knowledge, attitudes and practices regarding community-based health insurance in dembecha town,...
TRANSCRIPT
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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
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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
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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
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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.
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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).
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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
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Methods
1. Data analysis:• Descriptive statistics• Pearson Chi Square tests• Multivariate linear
regression • Multivariate logistic
regression2. Diagnostic tests:
• Histograms & normal distribution
• Multi-collinearity 7
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83 72
16
1728
84
Level of Knowledge, Attitude, and Practice
Top: PoorBottom: Good
Perc
enta
ge (%
)Result
8
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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%.
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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
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Determinants of Knowledge of CBHI
N=311R2= 27%
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Determinants of Attitudes Towards CBHI
N=311R2= 29%
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Level of Practices of CBHI
N=311R2= 28%
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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.
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Discussion
• The WTJ is 70% among non-members;• Utilization of CBHI is modest;• The under-utilization:
• The poor quality of care and unaffordability.
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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.
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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
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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
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Thank you! Questions? 19