Determinants of community-based health insurance implementation in west Gojjam zone, Northwest Ethiopia: a community based cross sectional study design.

BACKGROUND: In most developing countries, healthcare cost is mainly paid at the time of sickness and out-of-pocket at the point of service delivery which potentially could inhibit access. The total economic cost of illness for households is also estimated to be frequently above 10% of household income which is categorized as catastrophic. The purpose of this study was to assess factors that determine decisions to join the community based health insurance in West Gojjam zone. METHODS: A community based cross sectional survey was conducted to collect data from 690 household heads using a multistage sampling technique. A binary logistic regression was used to identify the determinants of household decisions for CBHI enrollment. RESULTS: Out of the participants, 58% were CBHI members. Besides, family size (AOR = 1.17; CI = 1.02-1.35), average health status (AOR = .380; CI = .179-.805), chronic disease (AOR = 3.42; CI = 1.89-6.19); scheme benefit package adequacy (AOR = 2.17; CI = 1.20-3.93), perceived health service quality (AOR = 3.69; CI = 1.77-7.69), CBHI awareness (AOR = 4.90; CI = 1.65-14.4); community solidarity (AOR = 3.77; CI = 2.05-6.92) and wealth (AOR = 3.62; CI = 1.67-7.83) were significant determinant factors for enrolment in the community based health insurance scheme. CONCLUSION: CBHI awareness, family health status, community solidarity, quality of service of health institutions, and wealth were major factors that most determine the household decisions to enroll in the system. Therefore, in-depth and sustainable awareness creation programs on the scheme; stratified premium- based on economic status of households; incorporation of social capital factors, particularly building community solidarity in the scheme implementation are vital to enhance sustainable enrollment. As perceived family health status and the existence of chronic disease were also found significant determinants of enrollment, the Government might have to look for options to make the scheme mandatory.

Health professionals' willingness to pay and associated factors for cervical cancer screening program at College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia.

INTRODUCTION: Cervical cancer is a major public health problem in developing countries like Ethiopia. Cervical cancer screening service has been offered to high-risk groups in Ethiopia since 2013. However, there is no evidence on the willingness to pay for the screening. Therefore, we conducted this study to assess the female health professionals' willingness to pay for cervical cancer screening at the College of Medicine and Health Sciences, University of Gondar, Northwest Ethiopia. METHODS: Institutional based cross-sectional study design was used to assess the health professionals' willingness to pay for the cervical screening from March to April, 2018. Simple random sampling technique was used to select study participants from a list of female health professionals who has been working for the College of Medicine and Health Sciences, University of Gondar. The data were entered into EpiData version 3.1 and exported to STATA version 14 for analysis. Tobit models were used to identify factors which had statistical significant association with willingness to pay for cervical cancer screening service. RESULTS: A total of 392 respondents participated in the study with a response rate of 92.7%. The majority (83.4%) of participants were willing to pay for cervical cancer screening. The average amount of money they were willing to pay was ETB 194.7 (US$7.16) per service. Age ≥ 30 years, educational status, perceived seriousness of cervical cancer, perceived quality of cervical cancer screening service and monthly income were significantly associated with willingness to pay for cervical cancer screening. CONCLUSION: High proportion of study participants were willing to pay for cervical cancer screening. Therefore, the policy makers can scale-up cervical cancer screening by setting appropriate fee for service charge. They can also raise awareness of cervical cancer and offer quality service in order to increase the benefits of the program.