Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis.

Background: Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia. Methods: Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI. Results: Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it. Conclusion: The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

Dropout rate and associated factors of community-based health insurance beneficiaries in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ethiopia aims to achieve universal healthcare using health insurance. To do so, it has been implementing community-based health insurance since 2011. However, the retention of members by the scheme has not yet been evaluated nationally. The systematic review and meta-analysis aimed to evaluate the dropout rate and associated factors among the scheme's beneficiaries in Ethiopia. METHODS: On December 19, 2022, searches were conducted in Scopus, Hinari, PubMed, Semantic Scholar, and Google Scholar. Searches were also conducted on the general web and electronic repositories, including the Ethiopian Health Insurance Service, the International Institute for Primary Health Care-Ethiopia, and various higher education institutions. The Joanna Briggs Institute's tools and the "preferred reporting items for systematic reviews and meta-analyses 2020 statement" were used to evaluate bias and frame the review, respectively. Data were analyzed using Stata 17 and RevMan 5. To assess heterogeneity, we conducted subgroup analysis and used a random model to calculate odds ratios with a p value less than 0.05 and a 95% CI. RESULTS: In total, 14 articles were included in the qualitative synthesis, of which 12 were selected for the quantitative analysis. The pooled estimate revealed that the dropout rate of beneficiaries from the scheme was 34.0% (95% CI: 23-44%), provided that the renewal rate was 66.0%, and was found to be influenced by socio-demographic, health status, length of enrolment, knowledge, attitude, the scheme, and health service-related variables. The southern and Oromia regions reported the lowest and highest dropout rates, with 27.0% (95% CI: 24-29%) and 48.0% (95% CI: 18-78%), respectively. The dropout rates increased from 12.3% in 2012-2015 to 34.4% in 2020-2021. CONCLUSION: More than one-third of the scheme's beneficiaries were found to have dropped out, and this has been found to increase over time, dictating that a community-based strategy and intervention, from the supply, insurer, and demand sides, seem indispensable in minimizing this huge dropout rate.

Pharmacy professionals' perceptions of their professional duties in the Ethiopian health care system: a mixed methods study.

BACKGROUND: Pharmacy professionals are experts in therapeutic knowledge, experience, and skills that are used to ensure desired patient outcomes, utilizing the best available clinical evidence and interventions in collaboration with the health care team. They perceive themselves as a provider of technical, standardized, and individualized advice. The objective of this study was thus to assess the perception of pharmacy professionals towards their current professional roles in the health care system in Dessie, a city in the north-east Ethiopian region. METHODS: A mixed-methods sequential explanatory study was used to assess the perception of pharmacy professionals towards their professional roles in Dessie city administration from December 15-30, 2019. The study participants were all pharmacy professionals working at health facilities in Dessie. Self-administered questionnaires were used to collect quantitative data, and face-to-face key informant interviews were used for qualitative data collection. Data were entered, processed, and analyzed using SPSS 25.0 statistical software, and thematic analysis was used for the qualitative exploration using QDA Miner Lite software (v2.0.7, free edition version). RESULT: The study had a 97.7% response rate. Of the 301 participants, 173 (57.5%) were male. Most of the participants had a positive perception, while 38 (12.6%) had a poor perception of their current professional roles. Lack of physical access, poor initiatives, poor communication skills, and a lack of administrative support for pharmaceutical care were statistically significant at a p value of 0.05 and a 95% confidence interval. From the qualitative data, two major themes emerged: perceived roles and determinants (perceived facilitators and barriers). CONCLUSION: Pharmacy professionals' roles were found to be influenced by a lack of physical access, poor initiatives, poor communication skills, and poor administrator support. Pharmaceutical care requires everyone's involvement in addressing these factors for successful performance and a better outcome and in considering perceived facilitators and barriers.

Corrigendum: Willingness to pay for social health insurance in Ethiopia: a systematic review and meta-analysis.

[This corrects the article DOI: 10.3389/fpubh.2023.1089019.].

Willingness to pay for social health insurance in Ethiopia: A systematic review and meta-analysis.

Background: Ethiopia plans to introduce social health insurance with the aim of giving recipients high-quality, long-term universal health care. It was anticipated to be fully operational in 2014. However, due to strong opposition from public employees, the implementation has been delayed multiple times. As a result, more and more studies have been conducted to collect evidence about the issue. However, there is no national pooled evidence regarding the willingness to pay for the scheme. Thus, this review aimed to evaluate the willingness to pay for social health insurance and associated factors in Ethiopia. Methods: On September 1, 2022, database searches were conducted on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Based on this search, 19 studies were included in the review. The risk of bias for the included studies was assessed using Joana Briggs Institute checklists. The data were extracted using Microsoft Excel. RevMan-5 was used to conduct the meta-analysis. The effect estimates assessed were the odds ratios at a p-value <0.05 with a 95% CI using the random effect model. Results: The pooled willingness to pay for social health insurance was 42.25% and was found to be affected by sociodemographic, health and illness status, health service related factors, awareness or knowledge level, perception or attitude toward the scheme, and factors related to the scheme. The pooled result showed that the willingness of participants to pay for the scheme was 16% less likely (OR = 0.84; 95% CI: 0.52-1.36). When the outlier was unchecked, the willingness to pay became 42% less likely (OR = 0.58; 95% CI: 0.37-0.91). The lowest willingness to pay for the scheme was in the Oromia region, while the highest was in Harar. Professionally, teachers were 3.22 times more likely to pay for the scheme (OR = 3.22; 95% CI: 1.80-5.76) than health professionals. Conclusion: The willingness to pay for social health insurance was low, <50%, particularly among health professionals, which urges the Ethiopian health insurance service to deeply look into the issue.

The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. OBJECTIVE: We evaluated the impact of Ethiopia's community-based health insurance (2012-2021) on universal health coverage. METHODS: On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. RESULTS: The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44-2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29-2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27-19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12-16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50-1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41-1.02). CONCLUSION: Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.

Medication Nonadherence and Associated Factors among Heart Failure Patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Background: Medication nonadherence, being one of the best predictors of hospitalization, increases the mortality rate and hospital readmission and reduces the quality of life of heart failure (HF) patients. Therefore, this study is aimed at assessing medication nonadherence and associated factors among HF patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods: A cross-sectional study was conducted among 245 adult patients with HF from June to August 2017. The data were collected by using the medication Adherence Report Scale (MARS-5) and then entered and analyzed using SPSS® (IBM Corporation) version 24. Summary statistics were presented using frequency, proportion, and mean. Binary logistic regression analysis was done for identifying factors associated with medication nonadherence with a 95% confidence level and p value of less than 0.05. Results: Among 245 patients with HF, about a quarter (23.7%) of them were medication nonadherent. More than one-third (37%) of HF patients had a history of at least one HF medication discontinuation. Refilling problems (48%) and getting better from the illness (27%) were the most commonly reported reasons for nonadherence. Presence of comorbidity (AOR = 2.761; 95%CI = 1.364, 5.589), taking three or more types of medication (AOR = 2.805; 95%CI = 1.404, 5.60), and being unmarried (AOR = 2.638, 95%CI = 1.279, 5.443) was significantly associated with medication nonadherence. Conclusion: The self-reported medication nonadherence among HF patients was considerably high. Refilling problems and getting better from the illness were the most commonly reported reasons for nonadherence. The presence of comorbid illness, taking three or more types of medication, and being unmarried was significantly associated factors of medication nonadherence. Awareness creation among patients on the importance of medication adherence and targeted efforts to assess and mitigate reasons for medication nonadherence may be helpful.

Quality of life and associated factors among patients with cancer receiving chemotherapy at Dessie Comprehensive Specialized Hospital, North-East Ethiopia: a cross-sectional study.

Background: Cancer is a major public health problem around the world. Cancer by itself and its treatment modalities affect the quality of life (QoL) of patients with it. However, there were a paucity of studies about the QoL of patients receiving chemotherapeutic treatment in Ethiopia. This study was aimed at addressing such a gap. Accordingly, we investigated QoL and associated factors among cancer patients receiving chemotherapy at Dessie Comprehensive Specialized Hospital (DCSH), North East Ethiopia, in 2023. Methods: We employed a cross-sectional study from April 1 to May 30, 2023. The data was collected using the European Organization for Research and Treatment of Cancer Core QoL Questionnaire, version 3.0 (EORTC QLQ-C30). The data was entered and cleaned using EpiData version 4.6 and exported to Statistical Package for Social Sciences (SPSS) version 27 for analysis. The association between the dependent and independent variables was determined using Odds Ratios (ORs) at a p value < 0.05 with a 95% CI. Results: Data was collected from 394 patients. Their mean summary QoL score was 36.3 ± 9.0. About 39.3% demonstrated a good QoL summary score, whereas 60.7% were impacted by symptoms. A good functional QoL score was observed in 42.6% of the participants. About 54.8% and 31.7% reported good overall health status and good overall QoL, respectively. The most impacted functional domain was social functioning, affecting 64.5% of participants. The most common symptom was diarrhea, affecting 65.5% of the participants. Secondary school education level (Adjusted Odds Ratio-AOR = 3.16, 95% CI: 1.14-8.81), diploma and above education level (AOR = 4.90, 95% CI: 1.29-18.62), and urban residency (AOR = 1.74, 95% CI: 1.07-2.82) had a significant positive association with QoL, while being a civil servant (AOR = 0.13, 95% CI: 0.04-0.49), having stage III cancer (AOR = 0.14, 95% CI: 0.05-0.39), and stage IV cancer (AOR = 0.16, 95% 0.06-0.44) had a significant negative association with it. Conclusion: The QoL for cancer patients undergoing chemotherapy was significantly low and associated with their level of education, occupational status, area of residence, and stage of cancer. Incorporating psychosocial support is thus crucial in their treatment plans.