KNOWLEDGE, ATTITUDE, AND PERCEPTION TOWARDS SOCIAL HEALTH INSURANCE AND ASSOCIATED FACTORS AMONG HEALTH PROFESSIONALS WORKING AT PUBLIC HEALTH FACILITIES IN GONDAR CITY, NORTH WEST ETHIOPIA
Abstract
Willingness to pay for and accept social health insurance varies across regions due to differences in knowledge, attitudes, and perceptions among employees. Ethiopia has introduced a social health insurance scheme despite facing challenges in its acceptance by the formal sector. However, little is known about the knowledge, attitudes, and perceptions of social health insurance. Therefore, this study aimed to assess the knowledge, attitudes, and perceptions regarding social health insurance and its associated factors among health professionals at public health facilities in Gondar City, Northwest Ethiopia. A facility-based cross-sectional and phenomenological design was used in this study. Four hundred and twenty-two participants and two focus group discussions were included for the quantitative and qualitative studies, respectively. A self-administered questionnaire and a focus group guide were used for data collection. Participants were selected using purposive and stratified simple random sampling techniques. EPI Data and Open Code software were used for data coding and entry, and the data was then exported to SPSS for analysis. Binary logistic regression and thematic analysis were used for quantitative and qualitative analysis, respectively. The results of the study suggested that knowledge and attitudes towards social health insurance were inadequate and unfavorable, despite positive perceptions found through quantitative analysis. Additionally, the qualitative findings suggested that knowledge, attitude, and perception were all poor. These findings highlight the need for targeted interventions to improve understanding and acceptance of social health insurance and to address negative attitudes towards it. By doing so, we can work towards increasing access to healthcare services and financial protection for individuals and families
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Social health insurance, Ethiopia, knowledge, attitude, perceptionDownloads
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References
Amo-Adjei J, Anku PJ, Amo HF, Effah MO (2016). Perception of quality of health delivery and health insurance subscription in Ghana. BMC health services research 16:1-11.
Acharya D, Devkota B, Bhattarai R (2021). Do people's perceptions and attitudes associate with enrollment in health insurance in a context of Nepal?. Nepalese Journal of Insurance and Social Security 4(1):1-18.
Adewole DA, Adebayo AM, Udeh EI, Shaahu VN, Dairo MD (2015). Payment for health care and perception of the national health insurance scheme in a rural area in Southwest Nigeria. The American Journal of Tropical Medicine and Hygiene 93(3):648.
Admasu K, Balcha T, Getahun H (2016). Model villages: a platform for community-based primary health care. The Lancet Global Health 4(2):e78-e79.
Agago TA, Woldie M, Ololo S (2014). Willingness to join and pay for the newly proposed social health insurance among teachers in Wolaita Sodo town, South Ethiopia. Ethiopian Journal of Health Sciences 24(3):195-202.
Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Achadi EL, Taher A, Wirawan F, Sungkar S, Sudarmono P, Shankar AH, Thabrany H (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet 393(10166):75-102.
Ahmed AA (2019) Acceptance and Satisfaction of National Health Insurance Scheme Services among Civil Servants in Sokoto Metropolis, Sokoto State-Nigeria.
Ahmed S, Hoque ME, Sarker AR, Sultana M, Islam Z, Gazi R, Khan JA (2016). Willingness-to-pay for community-based health insurance among informal workers in urban Bangladesh. PloS one 11(2):e0148211.
Alebachew A, Yusuf Y, Mann C, Berman P (2018). Ethiopia’s Progress in Health Financing and the Contribution of the 1998 Health Care and
Financing Strategy in Ethiopia. Resource Tracking and Management Project. Harvard TH Chan School of Public Health and Breakthrough International Consultancy, PLC. Boston: Massachusetts and Addis Ababa. Ethiopia. 2015.
Amo-Adjei J, Anku PJ, Amo HF, Effah MO (2016). Perception of quality of health delivery and health insurance subscription in Ghana. BMC health services research 16:1-11.
Amu H, Dickson KS, Kumi-Kyereme A, Darteh EKM (2018). Understanding variations in health insurance coverage in Ghana, Kenya, Nigeria, and Tanzania: evidence from demographic and health surveys. PloS one 13(8):e0201833.
Asenso-Okyere WK, Osei-Akoto I, Anum A, Appiah EN (1997). Willingness to pay for health insurance in a developing economy. A pilot study of the informal sector of Ghana using contingent valuation. Health policy 42(3):223-237.
Ballon BC, Skinner W (2008). “Attitude is a little thing that makes a big difference”: reflection techniques for addiction psychiatry training. Academic Psychiatry, 32:218-224.
Barasa E, Kazungu J, Nguhiu P, Ravishankar N (2021) Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries. BMJ Glob Health 6(4):e004712.
Bezuidenhout S, Matlala M (2014). Assessment of the knowledge of healthcare workers at Dr George Mukhari Academic Hospital, GaRankuwa, South Africa regarding the South African National Health Insurance Scheme: understanding the National Health Insurance Scheme. African Journal for Physical Health Education, Recreation and Dance 20(sup-1):234-243.
Birara D (2018). Reflections on the health insurance strategy of Ethiopia.
Chen W, Zhang Q, Renzaho AM, Zhou F, Zhang H, Ling L (2017). Social health insurance coverage and financial protection among rural-to-urban internal migrants in China: evidence from a nationally representative cross-sectional study. BMJ Global Health 2(4):e000477.
Ethiopia F (2015). Health Sector Transformation Plan (HSTP): 2015/16- 2019/20, Addis Ababa. Ethiopia.
Fang C, He C, Rozelle S, Shi Q, Sun J, Yu N (2019). Heterogeneous impacts of basic social health insurance on medical expenditure: Evidence from China’s new cooperative medical scheme. In Healthcare 7(4):131.
Fenny AP, Yates R, Thompson R (2018). Social health insurance schemes in Africa leave out the poor. International Health 10(1):1-3.
Gessesse AT. Berhe AA, Tilahun MG, Teklemariam TW (2020). Factors associated with willingness to pay for social health insurance among government employees in Tigrai region, Northern Ethiopia. eajahme 4(4).
Jacob A (2018). A study on customer perception towards health insurance in Ranny Thaluk. International Journal for Advance Research and Development 3(12):41-48.
Kokebie MA, Abdo ZA, Mohamed S, Leulseged B (2022). Willingness to pay for social health insurance and its associated factors among public servants in Addis Ababa, Ethiopia: a cross-sectional study. BMC Health Services Research 22(1):909.
Lan N, Anh HD (2017). Willingness to pay for social health insurance in central Vietnam.
Mathauer I, Schmidt JO, Wenyaa M (2008). Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand. The International Journal of Health Planning and Management 23(1):51-68.
Mekonen AM, Gebregziabher MG, Teferra AS (2018). The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: A cross sectional study. PloS one 13(10):e0205972.
Mekonnen WN, Wondaferew M, Mekonen AB (2019). Willingness to Join and Pay for Social Health Insurance Scheme Among employees in Debere Berhan Town, Ethiopia.
Mulatu B, Mekuria A, Tassew B (2020). Willingness to join and pay for Social Health Insurance among Public Servants in Arba Minch town, Gammo Zone, Southern Ethiopia..
Nadpara PA (2009). PHP67 Health status and attitudes towards health insurance in meps sample population. Value in Health 3(12):A90.
Nguyen LH, Hoang ATD (2017). Willingness to pay for social health insurance in central Vietnam. Frontiers in public health 5:225885.
Nosratnejad S, Rashidian A, Mehrara M, Sari AA, Mahdavi G, Moeini M (2014). Willingness to pay for social health insurance in Iran. Global journal of health science 6(5):154.
Obse A, Hailemariam D, Normand C (2015). Knowledge of and preferences for health insurance among formal sector employees in Addis Ababa: a qualitative study. BMC health services research 15:111.
Oladimeji O, Alabi A, Adeniyi OV (2017). Awareness, knowledge and perception of the national health insurance scheme (nhis) among health professionals in mthatha general hospital, eastern cape, south africa. The Open Public Health Journal 10(1).
Olugbenga-Bello AI, Adebimpe WO (2010). Knowledge and attitude of civil servants in Osun state, Southwestern Nigeria towards the national health insurance. Nigerian journal of clinical practice 13(4).
Omotowo IB, Ezeoke UE, Obi IE, Uzochukwu BSC, Agunwa CC, Eke CB, Idoko CA. Umeobieri AK (2016). Household perceptions, willingness to pay, benefit package preferences, health system readiness for National Health Insurance scheme in Southern Nigeria. Health 8(14):1630-1644.
Reshmi B, Unnikrishnan B, Parsekar SS, Rajwar E, Vijayamma R, Venkatesh BT (2021). Health insurance awareness and its uptake in India: a systematic review protocol. BMJ open 11(4):e043122.
Saimy IS, Juni MH, Rosliza AM (2016). Willingness to pay for health insurance and its associated factors among staff of local authorities in Petaling District, Selangor, 2016. International Journal of Public Health and Clinical Sciences 3(6):35-49.
Salameh AMM, Juni MH, Hayati KS (2015). Willingness to pay for social health insurance among academic staff of a public University in Malaysia. International Journal of Public Health and Clinical Sciences 2(5):21-32.
Sharma S, Banjara S (2020). Perception of Social Health Insurance Program among Community People in Pokhara, Nepal. Janapriya Journal of Interdisciplinary Studies 9(1):211-220
Spaan E, Mathijssen J, Tromp N, McBain F, Have AT, Baltussen R (2012). The impact of health insurance in Africa and Asia: a systematic review. Bulletin of the World Health Organization 90:685692.
Suthar AB, Khalifa A, Joos O, Manders EJ, Abdul-Quader A, Amoyaw F, Aoua C, Aynalem G, Barradas D, Bello G, Bonilla L (2019). National health information systems for achieving the sustainable development goals. BMJ open 9(5):e027689.
Tewele A, Yitayal M, Kebede A (2020). Acceptance for social health insurance among health professionals in government hospitals, Mekelle City, North Ethiopia. Adv Public Health 2020:6458425.
Uzochukwu BS, Ughasoro MD, Etiaba EA, Okwuosa C, Envuladu E, Onwujekwe OE (2015). Health care financing in Nigeria: Implications for achieving universal health coverage. Nigerian journal of clinical practice 18(4):437-444.
World Health Organization (WHO) (2018). The state of health in the WHO African region: an analysis of the status of health, health services and health systems in the context of the sustainable development goals.
Yang M (2018). Demand for social health insurance: evidence from the Chinese new rural cooperative medical scheme. China Economic Review 52:126-135.
Yazbeck AS, Savedoff WD, Hsiao WC, Kutzin J, Soucat A, Tandon A,
Wagstaff A, Chi-Man Yip W (2020). The Case Against Labor-TaxFinanced Social Health Insurance For Low-And Low-Middle-Income Countries: A summary of recent research into labor-tax financing of social health insurance in low-and low-middle-income countries. Health Affairs 39(5):892-897.
Yeshiwas S, Kiflie M, Zeleke AA, Kebede M (2018). Civil servants' demand for social health insurance in Northwest Ethiopia. Archives of Public Health 76:1-10.
