Community-Based Health Insurance and Associated Factors in North-Western Ethiopia. The Case of Bahir Dar City

BACKGROUND: Health insurance provides access to health care with financial risk protection. Knowledge and attitude have been found to influence enrolment in community-based health insurance, which avoids catastrophic health-care expenditure. However, knowledge and attitude levels towards health insurance are not well studied. The objective of this study was to determine the knowledge and attitude level of the informal workers of the Bahir Dar city towards community-based health insurance. METHODS: A community-based cross-sectional study was conducted with systematically selected 335 informal workers. We conducted structured face-to-face interviews using a newly developed and validated questionnaire. The collected data were coded and then entered into Epi data and exported to SPSS software for analysis. Logistic regression analysis was used to identify potential associations between the study variables. RESULTS: Out of 325 informal workers, 51% of them had good knowledge of community-based health insurance, while 56% of participants had a favorable attitude towards community-based health insurance. Being single (AOR=3.4, 95% CI; 1.3, 9.0), daily laborer (AOR=2.73, 95% CI; 1.36, 5.48), attending secondary education (AOR=0.29; 95% CI: 0.12, 0.71), and obtaining information from television (AOR=0.31, 95% CI; 0.14, 0.71) were found to be statistically associated with knowledge. While being single (AOR=0.23, 95% CI: 0.08, 0.67), married (AOR=0.29, 95% CI: 0.11, 0.73), daily laborer (AOR=2.84, 95% CI: 1.37. 5.88), getting information from television (AOR= 3.09, 95% CI: 1.37, 6.93) and family (AOR= 2.63, 95% CI: 1.23, 5.61) were found to be statistically associated with the attitude towards community-based health insurance. CONCLUSION: The knowledge and attitude level of the informal workers towards community-based health insurance were low. Therefore, community-based health insurance should be promoted to ensure the accessibility of health care to all.