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Table 1 Determinants of membership and non-membership in community-based health insurance (CBHI) in West Africa

From: Factors determining membership in community-based health insurance in West Africa: a scoping review

Article

Country

Method

Membership factors

Non-membership factors

Seck et al. [14]

Senegal

Retrospective cross- sectional study Quantitative approach Sample: 912 households

Individual characteristics

Higher literacy levels

Household size less than ten members

Determinants of care benefits

Short distance to a conventional health training

Individual characteristics

Rural environment

Large household size

Low literacy level of the head of the household

Over 60 years old

Financial capacity

Low-income level

Determinants of care benefits

Poor perception of quality of care

High distance from the health care facility

Turcotte-Tremblay et al. [15]

Benin

Multiple case study

Qualitative approach

Sample: 23 semi-structured interviews, two focus groups and 15 unstructured interviews

Financial capacity

Flexibility of payment

Determinants specific to CBHI

Raising awareness through door-to-door outreach

Government involvement

Individual characteristics

Low level of education

Determinants of care benefits

Poor quality of health care

Negative behaviour of health care professionals

Determinants specific to CBHI

Ignorance of the existence and benefits of CBHI organisations

Lack of current knowledge about strategies

Lack of public confidence

Poor communication

Unsuitable payment method

Lack of information

Onwujekwe et al. [16]

Nigeria

Cross-sectional study Quantitative approach Sample: 3070 randomly selected households

Determinants of care benefits

Improving access to good quality health services

Urban area

Formal education

Individual characteristics

Low level of education

Rural area

Determinants specific to CBHI

Distrust and cynicism about the success of the program

Financial capacity

Poor households

Determinants of care benefits

Geographical distance

Odeyemi  [17]

Nigeria

Literature review

Sample: 26 included studies

Financial capacity

Wealth

Financial grant from the government

Determinants specific to CBHI

Committing to providing private health insurance and services to low- and moderate-income families

Providing cardiovascular disease prevention care in a low-resource environment

Individual characteristics

Muslims (believed that CBHI was for the Christians)

Low level of education

Financial capacity

Low-income level

Lack of financial resources

Determinants specific to CBHI

Inadequate financial support for unrealistic enrolment requirements

Inability to tailor the implementation to a specific domain

Insufficient community involvement

Lack of confidence in the program and its management

Smith et al.  [18]

Mali, Senegal (and Ghana)

Cross-sectional evaluation study

Mixed approach (qualitative and quantitative)

Samples: 40 households (qualitative) and 1080 households (quantitative) in Senegal, 2280 households (quantitative) in Mali and 1806 households (quantitative) in Ghana

Individual characteristics

Catholics

Senofo ethnicity

Older women

Higher level of formal education of the head of the household

Higher socioeconomic status

Determinants of care benefits

Modern health care facility

Individual characteristics

Low level of education

Low household standard of living

Rural area

Financial capacity

Poverty

Determinants of care benefits

Quality of care

Distance

Determinants specific to CBHI

Lack of knowledge about the existence of CBHI

De Allegri et al.  [19]

Burkina Faso

Case-control study

Quantitative approach

Sample:154 enrolled households (cases) and 393 non-enrolled households (controls)

Individual characteristics

Higher level of education

Higher proportion of children living in the household

Individual characteristics

Bwaba ethnic group

Lower social status

Low level of education

Negative perception of the adequacy of traditional care

Determinants of care benefits

Greater distance from the health care facility

Gnawali et al. [20]

Burkina Faso

Case study

Quantitative approach

Sample: 1309 households

Individual characteristics

Membership in any other risk-sharing network

Number of children under five years of age

Individual characteristics

Low level of education of the head of the household

Larger households

Young people

Bwaba ethnic group

Financial capacity

Poor

Chankova et al.  [21]

Mali, Senegal (and Ghana)

Cross-country study

Quantitative approach Sample: 10,547 households (Mali), 9226 (Senegal) and 9553 households (Ghana)

Individual characteristics

Households headed by women

Higher household education

Higher household economic status

 

Dong et al. [22]

Burkina Faso

Household survey

Quantitative approach

Sample: 756 rural and 553 urban households

 

Individual characteristics

Female household head

Higher age or lower education of household head

Fewer children or elderly in household

Determinants of care benefits

Lower number of illness episodes in the past three months

Poor perceived health care quality

Less seeking care in the past month

Gankpe et al. [23]

Benin

Cross-sectional survey

Qualitative approach

Sample: 50 patients from three health centres (interviews and focus groups)

Individual characteristics

Family protection from the risk of illness

Determinants of care benefits

Receiving health care benefits in case of illness

Individual characteristics

Seniors

Large family size

Fon ethnic group

Woman

Financial capacity

Monthly income less than 30 000 CFA franc

Determinants of care benefits

Contribution for CBHI perceived as a waste in the absence of illness

Determinants specific to CBHI

Lack of trust in management committees

Distrust of CBHI leaders

Ignorance of the very existence of CBHI

Lack of knowledge of how CBHI work

Lack of knowledge of the benefits offered

Lyalomhe et al.  [24]

Nigeria

Cross-sectional research

Quantitative research approach

Sample: 372 respondents

Individual characteristics

Youth and middle-aged persons

Females

Married people

Determinants of care benefits

Higher use of hospitalization care

 

Jütting et al. [25]

Senegal

Cross-sectional study

Mixed approach (qualitative and quantitative)

Sample: 346 randomly selected households (2860 people)

Individual characteristics

Better financial protection against the risk of hospitalization

Sedentary of certain ethnic groups (Wolofs)

Determinants of care benefits

Short distance to the hospital

Good operation of the system

Individual characteristics

Mobility of certain ethnic groups (Fulani)

Financial capacity

Poor households

Determinants of care benefits

Inefficiency of health services

Franco et al. [26]

Mali

Case-control study

Sample: 817 member households and 787 non-member households

Determinants of care benefits

Closer distance to the conventional health care facility

Individual characteristics

Large household size

Residence far from a health care facility

The majority ethnic origin (Bambara)

Financial capacity

Very low-income level

Jütting et al. [27]

Senegal

Household survey data

Quantitative analysis

Sample: 346 households

Individual characteristics

Ethnic group of Wolof

Christian

Village characteristics

Financial capacity

Higher household income

 

Criel et al. [28]

Guinea

Cross-sectional study Mixed approach (qualitative and quantitative)

Sample: 12 focus groups of 8–12 respondents (137 participants)

Individual characteristics

Prediction of future illness

Preservation of health

Guarantee of health

Financial capacity

Avoiding financial difficulties

Determinants specific to CBHI

Guarantee of health insurance

Guarantee of health care

Individual characteristics

Large household members

Financial capacity

Difficulty in paying for all household members at the same time

Determinants of care benefits

Poor quality of care evidenced

Lack of good products

Determinants specific to CBHI

Lack of confidence in integrity

Lack of management skills

Sagna et al. [29]

Senegal

Literature review and in-depth interviews

Qualitative and exploratory approach

Sample: 40 heads of households and 12 focus groups

Financial capacity

Flexibility of payment either in cash or in kind

Financial capacity

Low-income level

Terms of payment of the difficult premium

Determinants of care benefits

Contents of the incomplete benefits package

Terms of payment of the difficult premium

Determinants specific to CBHI

Incomprehensible premium amount

Lack of availability of transportation

Level of co-payment

Absence of the guarantee between the agreement with the health institutions and the governance of the CBHI companies

Onwujekwe et al. [30]

Nigeria

Cross-sectional study

Mixed approach (qualitative and quantitative)

Sample: 3070 selected households

Individual characteristics

High level of education

Gender: men pay more than women

Financial capacity

Poor were in favour of the very low contribution and reported the lowest average amount

Financial capacity

Low socioeconomic status

Poverty

Determinants of care benefits

Remote location of residence

Souares et al. [31]

Burkina Faso

Cross-sectional study

Quantitative approach

Sample: 7762 households

Individual characteristics

Level of education

Financial capacity

Subsidies for the poorest

Wealth

Financial capacity

Poverty

Difficulty to pay full price to register

Mladovskya et al. [32]

Senegal

Case studies

Mixed approach (qualitative and quantitative)

Sample: 960 heads of households

Individual characteristics

Financial protection against the cost of ill health

Belonging to an association

Individual characteristics

Extended families

Financial capacity

Poverty

Low share capital

Ndiaye et al. [33]

Guinea

Documentary review and qualitative study

Individual characteristics

Ensuring access to quality essential emergency obstetric care

Financial capacity

Opportunity to save money

Financial capacity

Amount of women’s contributions

Determinants of care benefits

Poor quality of care

Lack of skills

Determinants specific to CBHI

Low involvement of communities

Lack of follow-up

Information marks

Onwujekwe et al. [34]

Nigeria

Cross-sectional study

Quantitative approach Sample: 971 respondents

Individual characteristics

Protection against financial risks

Determinants of care benefits

Availability of good quality treatment

Financial capacity

Unavailability of funds

Determinants of care benefits

Too poorly equipped provider facility

Determinants specific to CBHI

Lack of trust in responsible for managing the health care system

De Allegri et al.  [35]

Burkina Faso

Qualitative study

Sample: 32 households

Individual characteristics

Avoiding catastrophic spending

Guarantee of the treatment when sick

Financial capacity

Lack of financial means

Determinants of care benefits

Distance

Absence of a doctor in the village

Dissatisfaction with the quality of care

Determinants specific to CBHI

Lack of trust

Lack of knowledge and understanding

Institutional rigidity

Ridde et al. [36]

Benin

Exploratory study

Qualitative approach

Sample: 20 groups and 29 individuals

 

Financial capacity

Problems in being able to pay the premiums

Determinants of care benefits

Lack of trust in health care professionals

Determinants specific to CBHI

Lack of information

Ridde et al.  [37]

Benin

Cross-sectional study Qualitative approach

Individual interviews with members and non-members

Determinants specific to CBHI

Information that caregivers can no longer cause them harm

Impossible to do drug fraud

Financial capacity

Lack of financial means

Inability to pay the required premiums for membership

Determinants specific to CBHI

Lack of information about the risks covered

Alenda-Demoutiez et al. [38]

Senegal

Case study

Qualitative approach

Sample: 66 semi-structured interviews

Individual characteristics

Facilitation of access to care

Strengthening of social cohesion

Individual characteristics

Low level of education

Financial capacity

Poverty

Determinants specific to CBHI

Lack of information

Lack of awareness

Bastin [39]

Benin

Cross-sectional study

Qualitative approach (focus group)

Sample: 29 groups

Financial capacity

Reduction of poverty

Individual characteristics

Large family

Financial capacity

Lack of financial resources

Determinants of care benefits

Bad reception

Poor quality of care

Determinants specific to CBHI

Lack of information

Bonan et al. [40]

Senegal

Cross-sectional study

Quantitative approach

Sample: 360 households

Financial capacity

Willingness to pay

 

Koloma [41]

Burkina Faso

Cross-sectional study

Qualitative approach

Sample: 112 households

Financial capacity

Protection against potential disease risks Reduction of monthly health expenses

Improvement of well-being

Individual characteristics

Large family

Low level of education

Sow et al. [42]

Senegal

Cross-sectional study

Quantitative approach

Sample: 392 patients

Individual characteristics

Perception

Presence of an elderly person in the household

Household size

Determinants of care benefits

Pyramid medical institution

Determinants specific to CBHI

Confidence in CBHI

 

Mladovsky [43]

Senegal

Household cross-sectional survey

Quantitative analysis

Sample: 382 members and ex-members

Determinants specific to CBHI

Active mode of participation in the CBHI including training; voting, participating in a general assembly, awareness raising/information dissemination and informal discussions/spontaneously helping;

perceived trustworthiness of the scheme management/president, accountability and being informed of mechanisms of controlling abuse/fraud

Determinants of care benefits

Perception of poor quality of health services

Bousmah et al.  [44]

Senegal

Retrospective cross-sectional study

Quantitative approach

Sample: 1002 households

Individual characteristics

Individual risk preference

Determinants specific to CBHI

Health insurance awareness

Determinants of care benefits Geographic distance

Waelkens et al. [45]

Mauritania

Case study

Retrospective study over a ten-year period (2003 to 2012)

Qualitative approach

 

Determinants specific to CBHI

Ineffective procedures for premium collection

Complicated procedures for proving entitlement when seeking care

Poor understanding of multiple and complicated rules and regulation

Disinformation by recruiters with the aim to register high numbers

Distrust of members resulting of insufficient information, disinformation and mismanagement of funds

No perception of belonging and ownership by members

Poor performance of delegates in positions of responsibility, who had expected personal rewards

Exclusion of the poorest and large households; disinterest of wealthier households

Inaction of scheme leaders when faced with unexpected problems

De Allegri et al. [46]

Burkina Faso

Cross-country study

Qualitative approach Sample: 32 households

Determinants specific to CBHI

CBHI elements that match consumers’ needs and expectations in relation to their preference for the unit of enrolment, the premium level and the payment modalities, the benefit package, the health service provider network and the managerial structure

 

Mladovsky et al. [47]

Senegal

Three case studies

Qualitative evidence

Sample: 64 CBHI stakeholders

Determinants specific to CBHI

Subsidising the salaries of CBHI scheme staff

High sustainable internal and external governance structures through CBHI federations

CBHI resonance with local values concerning four dimensions of solidarity (health risk, vertical equity, scale and source)

Increased transparency in national policy Increased leaders’ negotiating power vis-à-vis health service providers

 

Rouyard et al.  [48]

Senegal

Retrospective study

Quantitative analysis

Sample: 676 CBHIs

Determinants specific to CBHI

Higher operational capacity

Presence of a salaried manager at the CBHI level

Stronger cooperation between CBHIs and local health posts

CBHIs located within a health facility enrolling fewer poor members

 

Bocoum et al.  [49]

Burkina Faso

Randomized experiment

Quantitative approach

Sample: 2000 households

Determinants specific to CBHI

CBHI information increases understanding in poorer households and in households with literate heads

 

Bonan et al. [50]

Senegal

Randomized controlled trial

Quantitative approach

Sample: 360 households

Determinants specific to CBHI

Insurance marketing treatments

 

Cofie et al.  [51]

Burkina Faso

Cross-country study

Quantitative and qualitative approach Sample: 250 households

Determinants specific to CBHI

Information, education and communication campaign

 

Yusuf et al. [52]

Nigeria

Cross-country study

Qualitative approach Sample: 419 respondents

Individual characteristics

Health insurance-related knowledge and attitudes