Skip to main content

Table 1 Literature search findings

From: Community-based health insurance programmes and the national health insurance scheme of Nigeria: challenges to uptake and integration

Reference

Type of paper

Main findings pertinent to the present analysis

Nigeria

Adinma, 2010 [21]

Descriptive cross-sectional study with interventional component carried out in 120 women of reproductive age at Obionu Health Centre, Igboukwu

Benefit shown for integration of maternal health services into CBHI schemes

Dienye, 2011 [22]

Questionnaire cross-sectional survey of 229 surgical patients who consented to the study

Patients paid for care mostly with personal savings; most were unaware of the NHIS. When informed, 84.3% were willing to enrol. Information must be disseminated to promote acceptance of CBHI in rural areas

Onwujekwe, 2010 [23]

Questionnaire survey of 3070 households selected by simple random sampling. Contingent valuation was used to determine WTP using the bidding game format. Correlations between socioeconomic status and geographic locations with WTP were investigated. Log-ordinary least squares was used to examine the construct validity of elicited WTP

Economic status and place of residence influence WTP for CBHI membership. Consumer awareness should be promoted, and government or donor subsidies are needed to ensure success and sustainability

Onwujekwe, 2010 [24]

Questionnaire survey of 3070 households selected by simple random sampling. Focus group discussions were used to collect qualitative data, which was then examined for links between benefit package preferences with socioeconomic status and geographic residence of the respondents

Rural and poorer households preferred comprehensive packages; urban dwellers and the better off preferred more basic packages. Long-term viability must be promoted by quick access to care and benefits, and reduction in cost of treatment

Onwujekwe, 2009 [25]

Questionnaire survey of 971 respondents in two communities selected by simple random sampling. Data analysis examined socioeconomic status, differences in enrolment levels, utilisation, willingness to renew registration, and payments

Highlighted the need for subsidies to ensure enrolment and equitable risk protection among the very poor

Onwujekwe, 2011 [26]

Questionnaire survey of 3070 randomly selected households. Head of household or most senior member interviewed, and acceptability of CBHI scored on a scale of 1 to 10

Greatest willingness to enrol detected among the poorest households. Less poor groups may be more aware of shortcomings in programmes, and may therefore be more likely to express distrust and cynicism about the success of the scheme

Senegal, Mali & Ghana

Jütting, 2003 [27]

Senegal

Survey of 346 randomly selected households (2860 persons): 70% members and 30% non-members. Models used to examine impact of CBHI on health care use and expenditure

Members more likely to use facilities than non-members, and pay substantially less when they do. The very poorest households do not enrol, however: cost of participation must be reduced by lowering of prices or addition of subsidies

Ouimet, 2007 [12]

Senegal

Study of all Senegal CBHI providers, including interviews with subscribers and promoters, logistical analysis of links between subscribers and organisations and composite indicators representing values

Showed conflicts between promoter and subscriber values

Smith, 2008 [28]

Senegal; Mali; Ghana

Data from three household surveys carried out by USAID-funded Partners for Health Reformplus. After presentation of descriptive statistics, multiple regression was used to estimate relationships between CBHI membership and access to formal maternal health services

CBHI membership is positively associated with maternal health service use. CBHI is a potential demand-side mechanism to increase maternal health care access, but complementary supply-side interventions to improve quality of and geographic access to care are also critical

Rwanda

Bucagu, 2012 [19]

Rwanda

Systematic review of literature, national policy documents and three Demographic & Health Surveys (2000, 2005 and 2010) to identify health system factors driving maternity service improvements

CBHI identified as a primary factor, together with better leadership and governance

Schmidt, 2006 [29]

Rwanda

Analysis of data from six household surveys

The goals of maximising health revenue and maximising participation in CBHI are mutually exclusive. The top three quartiles of the Rwandan population were able to contribute US$1 per capita per year, but subsidies were recommended to extend coverage to the poorest quartile

Dhillon, 2012 [30]

Rwanda

Investigation of the impact of subsidising CBHI enrolment, removing point-of-service co-payments, and improving service delivery on health facility utilisation rates in Mayange, a rural area containing approximately 25,000 people

Improvement of service delivery and reduced financial barriers (elimination of copayments and increased subsidies) increases health facility utilisation under CBHI

Schneider, 2006 [31]

Rwanda

Cross-sectional household survey data collected in 2000 in the context of the introduction of CBHI: 3139 households (354 insured and 2785 uninsured) - 14,574 individuals in total. Analysis via an indirect standardisation approach used to measure health inequality

Substantial inequality in utilisation linked to user fees - these were linked to horizontal inequity in service use across scheme members. In addition, benefit packages need to be large enough to protect households against catastrophic expenditure

Logie, 2008 [18]

Rwanda

Descriptive review summarising three health system developments introduced by the Rwandan government to lower barriers to care: coordination of donors and external aid with government policy, and monitoring the effectiveness of aid; a country-wide independent CBHI scheme; and the introduction of a performance-based pay initiative

Annual fee too expensive for the very poor and insufficient to fund basic care - extra central funding and donor contributions needed. Addition of contributions from other insurance schemes and exemptions for the poor recommended

Uganda

Basaza, 2010 [13]

Uganda

Semi-structured interviews with senior Ministry of Health staff and District Health Officers - qualitative study

Revealed gaps in knowledge and understanding of schemes among Ministry of Health and District Health Office staff. Also highlighted OOP expenditure as a problem

Basaza, 2007 [32]

Uganda

Case study of two CBHI schemes: review of scheme records, key informant interviews and exit polls with both insured and non-insured patients

Various demand and supply side factors identified

Basaza, 2008 [33]

Uganda

Reasons for low enrolment were investigated in two different models of CBHI. Focus group discussions and in-depth interviews were carried out with members and non-members to acquire more insight and understanding in people’s perception of CHI, in reasons for joining/not joining and in the possibilities for increased enrolment.

Highlighted scheme design problems, ability to pay premiums, poor quality of care, trust, etc.

Kyomugisha, 2009 [34]

Uganda

Qualitative descriptive cross-sectional study: focus group discussions with scheme members and non-members (158 participants)

Schemes were not sustainable because of small budgets, low enrolment and lack of government support. Effect of abolition of user fees on scheme enrolment was minimal. Governments should ensure that quality does not suffer when user fees are removed, and schemes need substantial support to build sustainability

Burkina Faso

De Allegri, 2006 [35]

Burkina Faso

In-depth interviews with 32 heads of households in Nouna District, BF

Previously neglected factors, such as institutional rigidities and socio-cultural practices, are important in shaping the decision to enrol

Dong, 2003 [15]

Burkina Faso

WTP study: household survey involving 2414 individuals and 705 household heads. Take-it-or-leave-it (TIOLI) and bidding game methods used to determine WTP

Pointed out the importance of considering differences between the theoretical and real markets, and between WTP and the costs of benefit packages

Dong, 2004 [16]

Burkina Faso

WTP survey: random sample of 698 household heads interviewed with bidding game method.

Decision makers need to consider WTP when setting enrolment units and premiums

Dong, 2004 [17]

Burkina Faso

Focus group discussions carried out after a pilot based on three key informant interviews; followed by a household survey (160 households). Qualitative survey with costings; the bidding game method was used to determine WTP and feasibility of running CBHI+

Subsidies highlighted; household characteristics influenced preferences

Dong, 2009 [36]

Burkina Faso

Survey of 756 rural and 553 urban households. logistic regression was used to study the influence of individual and household factors on CBHI drop-outs

Drop-out rates influenced by affordability, health needs and health demand, quality of care, and household head and household characteristics

Parmar, 2012 [37]

Burkina Faso

4-year study of adverse selection and targeted subsidies. CBHI was randomly offered to 41 villages and 1 town (Nouna) during 2004–6, with premium subsidies offered to poor households in 2007. Data were subsequently collected by household panel survey from randomly selected households (n = 6795); fixed effect models were applied

Targeted subsidies may increase coverage but may also increase adverse selection. Such subsidies for the very poor or other high-risk groups must be accompanied by strategies to bridge the financial gap created by adverse selection and thus assist sustainability

Souares, 2010 [38]

Burkina Faso

Community wealth ranking was used to identify the poorest quintile of households among 7762 in Nouna district who were then offered insurance at half the usual premium for 2007

Annual enrolment increased from 18 households (1.1%) in 2006 to 186 (11.1%) in 2007

Cameroon

Donfouet, 2011 [14]

Cameroon

Contingent valuation study based on survey of 410 rural households. Willingness to pay investigated

Substantial demand for CBHI in rural Cameroon, but social marketing strategies such as mass media campaigns are needed to raise awareness

Guinea

Criel, 2003 [39]

Guinea

Focus group discussions carried out to explore reasons for low enrolment

Poor quality of care highlighted as a factor

  1. CBHI, community-based health insurance; NHIS, National Health Insurance Scheme; WTP, willingness to pay.