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Aims: Rural dwellers are forced into a vicious circle of lack of financial risk protection to accessing non-optimal care and more poverty from its complications because out-of-pocket payment is their mainstay health care financing option. A sustainable and effective Community-based health insurance scheme will offer some respite. The study aimed to determine household heads’ willingness to participate and pay into a community-based health insurance scheme and the associated factors.
Study Design: Descriptive cross-sectional.
Place and Duration of Study: Imesi-Ile, a rural community in Obokun Local government area of Osun state, Nigeria between July and September, 2015.
Methods: Study population were 147 of the 155 household heads selected via a multi-stage sampling technique. Quantitative data collection was done using a structured questionnaire. The household health status, level of trust and reciprocity in the community, their awareness of a community-based health insurance scheme and their willingness to participate and pay into it using the double contingent valuation method were assessed. Data was analysed using the IBM SPSS version 20 software and statistical significance determined at p<0.05.
Results: There was a low level of awareness (13.6%), but majority (87.1%) were willing to participate after being informed. Only 54(42.2%) were willing to pay ₦12,000 ($33.3). The maximum amount they were willing to pay was ₦6000 ($16.7). Younger household heads (p=0.009), males (p=0.032), earning ≥₦6000 ($16.7) monthly (p=0.006), and involved in cooperative schemes (p=0.002) were significantly more willing to participate in the scheme. While the sex of the household heads (p=0.006) and mean score on reciprocity (p=0.002) were significantly associated with paying ₦12,000 ($33.3) as premium for a household of 6 persons. The preferred frequency of payment was monthly (53.8%).
Conclusion: The household heads in Imesi-Ile community were willing to participate and pay into the scheme. However, further studies on the feasibility and sustainability of implementation is advised.
National Population Commission (NPC) Nigeria and ICF. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria and Rockville, Maryland, USA: NPC and ICF; 2019.
Salari P, Di Giorgio L, Ilinca S, Chuma J. The catastrophic and impoverishing effects of out-of-pocket healthcare payments in Kenya. BMJ Glob Heal [Internet]. 2019; 4(6):1–13. [cited 2020 Aug 12]. Available from: http://gh.bmj.com/
Okonofua FE. Medical practice in a depressed economy. In: Edo State Nigerian Medical Association Annual General Meeting [Internet]. Benin City, Nigeria; 2016. [cited 2020 Aug 12]. Available:https://oer.unimed.edu.ng/CONFERENCES/1/3/F-E-Okonofua-NMA-presentation-Medical-Practice-in-a-Depressed-Economy.pdf
Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Aff. 2007;26(4):972–83.
World Health Organisation. Community based health insurance [Internet]. Newsroom Factsheet. Siwtzerland; 2020. [cited 2020 Aug 12]. Available:https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-2020
William FM, Ichoku HE, Ataguba JE-O. Paying for community-based health insurance schemes in Rural Nigeria: The use of in-kind payments. African Rev Money Financ Bank [Internet]. 2010;109–28. [cited 2020 Aug 12]. Available:https://www.researchgate.net/publication/228268690_Paying_for_Community-Based_Health_Insurance_Schemes_in_Rural_Nigeria_The_Use_of_In-Kind_Payments
Odeyemi IA. Community-based health insurance programmes and the national health insurance scheme of Nigeria: Challenges to uptake and integration. Int J Equity Health [Internet]. 2014;13(1):1–13. [cited 2020 Aug 12]. Available:International Journal for Equity in Health
Babatunde RO, Oyedeji O, Omoniwa E, Adenuga AH. Effect of community based health insurance on the livelihood of rural households. J Agric Fac Gaziosmanpasa Univ [Internet]. 2016;33(2):19–27. [cited 2020 Aug 12]. Available:https://www.researchgate.net/publication/308302073_Effect_of_Community_Based_Health_Insurance_on_the_Livelihood_of_Rural_Households
Dror DM, Chakraborty A, Majumdar A, Panda P, Koren R. Impact of community-based health insurance in rural India on self-medication & financial protection of the insured. Indian J Med Res [Internet]. 2016; 143(6):809–820. [cited 2020 Aug 12]. Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094122/
Christian Aid. A review of community- based health insurance schemes: Lessons from Nigeria and Ghana [Internet]. Abuja, Nigeria: Christian Aid; 2015. [cited 2020 Aug 12]. Available:https://www.christianaid.org.uk/sites/default/files/2016-11/Nigeria-review-of-community-based-health-insurance-schemes-Sept-2015_0.pdf
Garedew MG, Sinkie SO, Handalo DM, Salgedo WB, Yitebarek Kehali K, Kebene FG, et al. Willingness to join and pay for community-based health insurance among rural households of selected districts of Jimma Zone, Southwest Ethiopia. Clin Outcomes Res [Internet]. 2020;12:45–55. [cited 2020 Aug 12]. Available:https://www.dovepress.com/willingness-to-join-and-pay-for-community-based-health-insurance-among-peer-reviewed-article-CEOR
Trading Economics. Nigeria - proportion of population spending more than 10% of household consumption or income on out-of-pocket health care expenditure (%) [Internet]; 2020. [cited 2020 Aug 12]. Available:https://tradingeconomics.com/nigeria/proportion-of-population-spending-more-than-10percent-of-household-consumption-or-income-on-out-of-pocket-health-care-expenditure-percent-wb-data.html
Bamidele J, Adebimpe O. Awareness, Attitude and willingness of artisans in Osun State Southwestern Nigeria to participate in community based health insurance. J Community Med Prim Heal Care. 2012; 24(1–2):1-10–10.
Banwat M, Agbo H, Hassan Z, Lassa S, Osagie I, Ozoilo J, et al. Community based health insurance knowledge and willingness to pay; A survey of a rural community in North Central Zone of Nigeria. Jos J Med [Internet]. 2011;6(1):54–9. Available:http://www.ajol.info/index.php/jjm/article/view/78884/69208
Fadlallah R, El-Jardali F, Hemadi N, Morsi RZ, Abou-Samra, Clara Abou Ahmad A, Arif K, et al. Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review. Int J Equity Heal [Internet]. 2018;17(1):13. [cited 2020 Aug 12]. Available:10.1186/s12939-018-0721-4
Ogben C, Ilesanmi O. Community based health insurance scheme: Preferences of rural dwellers of the federal capital territory Abuja, Nigeria. J Public Health Africa. 2018;9(1).
Babatunde R, Oyedeji O, Omoniwa A, Adenuga A. Willingness-to-pay for community based health insurance by farming households: A case study of hygeia community health plan in Kwara State, Nigeria. Trakia J Sci [Internet]. 2016;14(3):281–6. [cited 2020 Aug 14]. Available:https://www.researchgate.net/publication/309218681_Willingness-to-pay_for_community_based_health_insurance_by_farming_households_A_case_study_of_hygeia_community_health_plan_in_Kwara_State_Nigeria
Plecher H. Nigeria: Inflation rate from 2004 to 2021 [Internet]; 2020. [cited 2020 Aug 14]. Available:https://www.google.com/search?safe=active&sxsrf=ALeKk03b7W4dCYNOEUudKWGqnzRab3ALOw%3A1597399863165&ei=N2M2X_rBCb7T1fAPq8qbsAY&q=https%3A%2F%2Fwww.statista.com%2Fstatistics%2F383132%2Finflation-rate-in-nigeria%2F&oq=https%3A%2F%2Fwww.statista.com%2Fstatistics%2F383132%2Finflation-rate-in-nigeria%2F&gs_lcp=CgZwc3ktYWIQAzIECCMQJzoECAAQR1D2GVj2GWDiKmgAcAF4AIAB5QKIAeUCkgEDMy0xmAEAoAEBqgEHZ3dzLXdpesABAQ&sclient=psy-ab&ved=0ahUKEwi6uaGbuprrAhW-aRUIHSvlBmYQ4dUDCAw&uact=5