Perception of Members toward Community-Based Health Insurance (CBHI Program, in Ethiopia: Insight from customer satisfaction national survey

Abstract Background This study investigates the perceptions of Community-Based Health Insurance (CBHI) holders across various regions and demographic factors in Ethiopia, focusing on their views regarding key aspects of the CBHI program. CBHI initiatives are crucial for enhancing healthcare access and providing financial protection, especially in low- and middle-income countries. In Ethiopia (since 2011), the CBHI program has been part of broader health sector reforms aimed at reducing out-of-pocket (OOP) healthcare expenses and improving service delivery 1. Method This study employs data from a national customer survey and analyzes responses from CBHI members, who rated aspects such as registration, contribution rates, service efficiency, and travel costs on a five-point Likert scale. This national survey employed a correctional study design and a questionnaire as a data collection tool. Descriptive statistics, chi-square tests, and composite variable scoring were used to interpret the data. Result the Key findings reveal a strong positive perception of the registration process, with 91% of respondents viewing it favorably and 88% finding the contribution rates fair. These elements are crucial for member retention and the sustainability of the CBHI scheme. However, only 75% of the respondents were satisfied with the convenience of services provided under the CBHI, indicating significant areas for improvement, particularly in terms of the efficiency and quality of healthcare services. The study also highlights substantial regional differences, with Dire Dawa showing the highest positive perceptions and Benishangul Gumuz the lowest. Additionally, factors such as age, employment status, duration of CBHI membership, healthcare usage, residence, and awareness level significantly influenced members' perceptions. Conclusion and Recommendation: The findings underscore the need to address region-specific challenges and demographic disparities within the CBHI program. While highly positive perceptions of registration and contribution fairness are encouraging, less favorable views of service convenience and regional disparities suggest uneven program implementation. To improve CBHI effectiveness, policymakers should focus on enhancing service convenience, particularly in regions with higher negative perceptions, through better resource allocation, staff training, and infrastructure improvements. Addressing demographic disparities, particularly among rural populations, younger age groups, and lower-income households, is also essential. Future research should explore these disparities further and evaluate the long-term impact of the CBHI on healthcare access and financial protection.