Assessment of Willingness to pay for Community-Based Health Insurance among Artisans in a selected Community of Ekiti State, Southwest Nigeria

Background: Community-based health insurance (CBHI) has emerged as a more efficient and equitable approach to healthcare financing. It was designed to ensure that sufficient resources are made available for members to access effective healthcare. This study assessed the willingness to pay (WTP) for CBHI among artisans in a town in Ekiti State, South West Nigeria. Methods: This was a cross-sectional survey conducted among 416 artisans in a town in Ekiti State. A semi-structured interviewer-administered questionnaire was designed and used for data collection on sociodemographic data and WTP for CBHIS. Data entry and analysis was done using IBM SPSS software version 25.0. Results: The mean age and standard deviation of the respondents was 29.7±10.9 years with male to female ratio of 1:1.4. Most of the respondents were willing to pay (86.3%) and willing to enroll other household members (73.6%) in the CBHI. A large percentage (44.3%) of those willing to pay were ready to pay between ₦1,000-₦5,000 (US$2.63­US$13.16) per year while 39.6% preferred frequency of payment to be annually. Positive predictors of WTP for CBHI were age groups ≥50 years and 40-49 years than <20 years (AOR:13.270, 95%CI: 1.597-110.267; AOR:142.996, 95%CI: 10.689-1913.009). Females than males (AOR:9.155, 95%CI: 3.680-22.775), tertiary level of education than no formal of education (AOR:23.420, 95%CI: 1.648-850.921), no children than ≥5 children (AOR:20.099, 95%CI: 2.705-149.364), earn ≥₦30,000 (US$78.95) than <₦30,000 (AOR:2.248, 95%CI: 1.278-6.499). often and somethings fall ill than seldom fall ill (AOR:6.505, 95%CI: 1.623-26.065; AOR:4.889, 95%CI: 1.674-14.279) Conclusion: WTP for CBHI was high among the artisans, however, there is a variation across the amount and frequency of payment. Therefore, policy that is flexible enough to allow artisans enroll and pay a premium that is affordable, at an acceptable frequency, should be formulated by the Government.

Reforms for financial protection schemes towards universal health coverage, Senegal

Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, la Couverture Maladie Universelle. One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country

Development of self-help groups for caregivers of children with disabilities in Kilifi, Kenya: process evaluation

Background: Caring for a child with disabilities in a resource-poor setting brings many challenges to the caregiver. We examined the development of self-help groups for caregivers in a rural part of Kenya. Objectives: To conduct a process evaluation on the development of self-help groups during a 10-month set-up period, focusing on implementation and mechanisms associated with their functional status. Methods: Using a realist evaluation design, we set up 20 self-help groups for 254 caregivers. An evaluation was conducted to investigate implementation and mechanisms of impact. Implementation focused on caregiver registration, community group support and monitoring visit compliance. Data were collected from group registers, records of meetings and field notes. Mechanisms of impact employed a framework of strengths­weaknesses­opportunities­threats to review the groups at the end of the 10-month set-up period. Results: Recruitment resulted in registration of 254 participants to 18 groups ­ two groups disbanded early. Post-evaluation included 11 active and 7 inactive groups. Compliance with the monitoring visits was consistent across the active groups. All groups engaged in 'merry-go-round' activities. The active groups were characterised by strong leadership and at least one successful income generation project; the inactive had inconsistent leadership and had dishonest behaviour both within the group and/or externally in the community. Mediators associated with functional status included the following: available literacy and numeracy skills, regular meetings with consistent attendance by the members, viable income generating projects, geographical proximity of membership and strong leadership for managing threats. Conclusion: Self-help groups have the potential to progress in resource-poor settings. However, critical to group progression are literacy and numeracy skills amongst the members, their geographical proximity, regular meetings of the group, viable income generating projects and strong leadership

Crise do seguro saúde no Chile: doença crônica socialmente transmissível / Crisis of health insurance in Chile: chronic socially transmissible disease / Crisis del aseguramiento de la salud en Chile: enfermedad crónica socialmente transmisible

No Chile, desde o início da seguridade social em saúde sob responsabilidade estatal, em 1924, instalou-se uma crise de legitimidade da proteção social à saúde, porque nunca foi materializado o princípio da universalidade e os diferentes sistemas implantados excluíram a segmentos da população, gerando fragmentação e desigualdades. Serão desenvolvidas idéias sobre a persistente fragmentação classista do sistema de saúde enquanto forma de reprodução social, quase imune às concepções progressistas e à análise crítica de algumas propostas de mudanças estruturais. OBJETIVO: Analisar a evolução sócio-histórica da seguridade social em saúde no Chile, entre 1924 e 2018. METODOLOGIA: Ensaio. CONCLUSÕES: A luta por mudar o paradigma ideológico-hegemônico produz uma trajetória política em ziguezague. O caso chileno mostra poucos avanços e múltiplos retrocessos na garantia do direito à saúde. Observa-se una previdência social fragmentada com multiplicidade de sistemas de saúde; grande desigualdade nos resultados; contradição entre a herança estatista dos primeiros anos do século XX e a profunda neoliberalização da garantia propiciada pela ditadura. A fragmentação clássica dos sistemas de saúde e sua reprodução social, quase impermeável às concepções realmente próximas dos princípios da seguridade social, é o que chamamos de "doença socialmente transmissível". (AU)

In Chile, since the beginning of the social security in health with State responsibility in 1924, a crisis of legitimacy of social protection in health has been installed, because the universality has never been fulfilled, the different systems implemented exclude some part of the population, generating fragmentation and inequality. We will develop ideas regarding the class fragmentation, as a form of social reproduction, almost impervious to more progressive conceptions and critical analysis of some proposals for structural changes. OBJECTIVE: To make a socio-historical analytical pathway of social security in Chilean health between 1924 and 2018. METHODOLOGY: Assay. CONCLUSIONS: The struggle to change the hegemonic ideological paradigm produces a zigzagging political trajectory. The Chilean case shows few advances and multiple setbacks in the consolidation of the right to health and its assurance. We find a fragmented social security with a multiplicity of health systems; great inequality in the results, contradiction between the statist inheritance of the first decades of the 20th century and the acute neoliberalization of the assurance instalated in the dictatorship.Classical fragmentation of health systems and their social reproduction, almost impervious to conceptions truly close to the principles of social security, is what we call "socially transmissible disease". (AU)

En Chile, desde el inicio de la seguridad social en salud de responsabilidad del Estado en 1924, se ha instalado una crisis de legitimidad de la protección social en salud, ya que nunca se cumplió con el principio de universalidad, los diferentes sistemas implementados excluyen alguna parte de la población, generando fragmentación e inequidad. Desarrollaremos ideas respecto de la fragmentación clasista perpetuada, como forma de reproducción social, casi impermeable a concepciones más progresistas y análisis crítico de algunas propuestas de cambios estructurales. OBJETIVO: Realizar un recorrido analítico socio-histórico de la seguridad social en salud chilena entre 1924 y 2018. METODOLOGÍA: Ensayo. CONCLUSIONES: La lucha por cambiar el paradigma ideológico hegemónico, produce una trayectoria política zigzagueante. El caso chileno muestra pocos avances y múltiples retrocesos en la consolidación del derecho a la salud y su aseguramiento. Encontramos una seguridad social fragmentada con multiplicidad de sistemas de salud; gran inequidad en los resultados, contradicción entre la herencia estatista de los primeros años del siglo XX y la aguda neoliberalización del aseguramiento propiciados por la dictadura.La fragmentación clasista de los sistemas sanitarios y su reproducción social, casi impermeable a concepciones verdaderamente cercanas a los principios de la seguridad social, es lo que denominamos como "enfermedad socialmente transmisible". (AU)

Fazeres em Saúde Coletiva / Dos in Public Health

O campo de conhecimento da Economia da Saúde foi construído nas últimas décadas do século passado e surge juntamente com a intensificação da introdução de novas tecnologias na área da saúde. Esse fato teve como consequência o aumento da qualidade e da expectativa de vida da população, mas os custos com o provimento desses serviços cresceram de forma exponencial em todo o mundo. Trouxeram consigo a discussão sobre os recursos necessários para o financiamento dessas ações, sobre a eficiência, eficácia e equidade dos diferentes modelos de atenção de saúde, sobre o papel dos sistemas de saúde para o desenvolvimento e crescimento econômico, entre outros. No Brasil, avançamos no sentido de assegurar a saúde como direito de cidadania, mas a dificuldade para assegurar o financiamento desse direito é evidente. A busca de respostas para essas questões tem sido um desafio e tem gerado muitas investigações nas universidades e instituições de pesquisa