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 |