Sustainability of Community Health Insurance Schemes in Kabale Diocese After the Withdrawal of External Funding
Abstract
One of the major challenges facing the entire global health financing is to develop systems that are able to protect people against the financial risks of obtaining healthcare. This would enable them seek needed healthcare services at the time when they need them, without the risks of financial catastrophe and impoverishment. To address this challenge, Community Health Insurance (CHI) is responds as one of the cost-effective interventions. However, enrolment in most CHI schemes all over the globe has remained low thereby limiting their sustainability. A case in question is the CHI scheme in Kabale diocese, Kigezi region which to date serves only 17,000 members despite over 18 years of existence in the area.
A descriptive, cross sectional survey was carried out among CHI members and non CHI members at household level; CHI scheme management board members; Household leaders- under the umbrella Kabale diocese community health insurance (KDCHIS); so as to assess the sustainability of community health insurance basing on levels enrolment and retention of house hold into the scheme. The study involved 6 Focus Group Discussions (FGDs) 4 with CHI members, 2 with non CHI members; interviews with: 183 household heads, 6 community health insurance schemes of Kabale diocese (CHIS) and 3 board members and 4 managers. This was determined to identify factors that affect enrolment and strategies for scaling up of CHIS.
Study results point to levels of education; distance to nearest CHI provider; knowledge of CHI; Attitude/perception of household heads` towards CHI; preferred alternative to finance healthcare provision. The benefit package offered by the scheme; trust in the management of the scheme as well as preferred mode and form of payment for health care, were identified as the key factors contributing to low enrolment in the KDCHI scheme. These factors influencing enrolment in CHI in Kabale diocese were majorly community related.
However, the scheme has got providers and managers who are very knowledgeable in the concepts of CH which if maximally utilized could address most factors that could be contributing to the low enrolment. Measure taken to for sustainability are corrective sensitization that involves religious plat form local leaders and political leaders, proper supervision to control over use of health facilities and proper accountability to ensure appropriate financial use of resources and hence improve scheme coverage and sustainability of the schemes.
The Church, the government of Uganda and other development partners should support and encourage education beyond the current universal primary and secondary education, to also cater for universal tertiary education, as knowledge of CHI greatly contributed to low enrolment in the scheme. More so, management of the diocese; and CHIS service providers should translate the knowledge levels they possessed, into understanding of CHI among the targeted community members as well as extending CHI services nearer to the targeted communities among others, as these would positively contribute to increased enrolment in the area.
One of the major challenges facing the entire global health financing is to develop systems that are able to protect people against the financial risks of obtaining healthcare. This would enable them seek needed healthcare services at the time when they need them, without the risks of financial catastrophe and impoverishment. To address this challenge, Community Health Insurance (CHI) is responds as one of the cost-effective interventions. However, enrolment in most CHI schemes all over the globe has remained low thereby limiting their sustainability. A case in question is the CHI scheme in Kabale diocese, Kigezi region which to date serves only 17,000 members despite over 18 years of existence in the area.
A descriptive, cross sectional survey was carried out among CHI members and non CHI members at household level; CHI scheme management board members; Household leaders- under the umbrella Kabale diocese community health insurance (KDCHIS); so as to assess the sustainability of community health insurance basing on levels enrolment and retention of house hold into the scheme. The study involved 6 Focus Group Discussions (FGDs) 4 with CHI members, 2 with non CHI members; interviews with: 183 household heads, 6 community health insurance schemes of Kabale diocese (CHIS) and 3 board members and 4 managers. This was determined to identify factors that affect enrolment and strategies for scaling up of CHIS.
Study results point to levels of education; distance to nearest CHI provider; knowledge of CHI; Attitude/perception of household heads` towards CHI; preferred alternative to finance healthcare provision. The benefit package offered by the scheme; trust in the management of the scheme as well as preferred mode and form of payment for health care, were identified as the key factors contributing to low enrolment in the KDCHI scheme. These factors influencing enrolment in CHI in Kabale diocese were majorly community related.
However, the scheme has got providers and managers who are very knowledgeable in the concepts of CH which if maximally utilized could address most factors that could be contributing to the low enrolment. Measure taken to for sustainability are corrective sensitization that involves religious plat form local leaders and political leaders, proper supervision to control over use of health facilities and proper accountability to ensure appropriate financial use of resources and hence improve scheme coverage and sustainability of the schemes.
The Church, the government of Uganda and other development partners should support and encourage education beyond the current universal primary and secondary education, to also cater for universal tertiary education, as knowledge of CHI greatly contributed to low enrolment in the scheme. More so, management of the diocese; and CHIS service providers should translate the knowledge levels they possessed, into understanding of CHI among the targeted community members as well as extending CHI services nearer to the targeted communities among others, as these would positively contribute to increased enrolment in the area.
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