Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review

Table 4 Summary of key findings under governance arrangement level of health system

Systems-level factors: Governance arrangement	Number and type of studies ^a	Reported as barriers	Reported as facilitators	Related to ^b
Systems-level factors: Governance arrangement	Number and type of studies ^a	Reported as barriers	Reported as facilitators	Implementation	Uptake	Sustainability
Stakeholder involvement	N = 3 Qualitative (2); Case study (1)	N = 3 [46, 48, 62]	–	X
Political economy context	N = 6 Qualitative (1); Mixed (3); Case studies (2)	N = 5 [31, 55, 59, 63, 75]	N = 1 [58]	X	X	X
Government support	N = 7 Qualitative (4); Mixed (2); Case study (1)	N = 2 [47, 75]	N = 5 [40, 48, 55, 61, 74]		X	X
Management and administrative structure	N = 12 Qualitative (3); Cross-sectional (2); Mixed (4); Case studies (3)	N = 8 [32, 44, 46, 48, 49, 62, 73, 83]	N = 5 [33, 41, 48, 55, 58]	X		X
Capacity of insurer promoters	N = 3 Mixed (2); Case study (1)	N = 2 [47, 48]	N = 1 [61]	X	X	X
Package content	N = 9 Qualitative (2); Cross-sectional (4); Mixed (2); Case study (1)	N = 5 [4, 48, 53,54,55, 61]	N = 5 [4, 33, 54, 56, 66]		X
Membership size	N = 3 Qualitative (2); Crosss-sectional (1)	N = 2 [57, 61]	N = 1 [36]			X
Membership criteria	N = 10 Qualitative (4); Cross-sectional (3); Mixed (3)	N = 7 [40, 47, 52, 54, 61, 62, 76]	N = 5 [33, 61, 73, 76, 84]		X	X

^a Some of the studies included both barriers and facilitators
^b X symbol denotes whether the factor relates to implementation, uptake or sustainability

ISSN: 1475-9276