Ethiopia’s community-based health insurance

The program was launched in 2011 in 13 districts across four regions, targeting a population of 1.8 million. The CBHI design covers services at health centers and secondary hospitals, with contributions ranging from US $0.50 to $0.80 per household per month. There are no copayments or user fees, and a one-month waiting period is required before accessing services. A 50% penalty is imposed for accessing hospital services without a referral. The CBHI structure involves community meetings to enroll households and manage the scheme. Contributions from members account for 52% of the total revenue, while government subsidies make up 48%. The government provides two types of subsidies: targeted subsidies for the poor, covering 10% of the population, and general subsidies for all members, covering 25% of the contribution. The government also funds three CBHI staff per district and covers operational costs. The CBHI program has been designed to address the low health service utilization in Ethiopia, where households spend 34% of their out-of-pocket income on healthcare. The program aims to increase access to healthcare services, particularly for the informal sector population, which accounts for 85% of the country's workforce. The CBHI program is part of the government's efforts to achieve universal health coverage and reduce poverty. The Ethiopian context is characterized by a large informal sector population, with 94.1 million people living in the country as of 2013. The life expectancy is 63 years, and 29.6% of the population lives in poverty. The annual per capita income is $470, and household out-of-pocket spending on healthcare is 34% of the total. The country has made significant progress in reducing child mortality, with the under-5 mortality rate declining from 204 deaths per 1,000 live births in 1990 to 67 deaths per 1,000 live births in 2011. The CBHI program is part of the government's efforts to strengthen the health system, which has received major investment since the 1990s. The program has been designed to build on the existing health infrastructure, including health posts and health centers. The program's success will depend on the effective management of the scheme, the engagement of community members, and the continued support of the government.