Community-based Health Insurance Membership Renewal and Associated Factors among Communities in Addis Ababa, Ethiopia

IntroductionUtilization of contemporary health services in developing nations has remained low. Ethiopia has introduced community-based health insurance (CBHI) to improve access to health services and reduce out-of-pocket payments. However, high dropout and low enrolment rates hamper implementation of CBHI scheme. This study aimed to assess CBHI membership renewal and associated factors among communities in Addis Ababa. MethodsCommunity-based cross-sectional mixed study design was employed among 626 CBHI members and ten key informants in Addis Ababa from July 05 to August 30, 2021. Multi-stage sampling technique was used to select study participants, and purposive sampling technique was used to select key informants. Quantitative data was collected using structured interviewer administered questionnaire and analyzed using SPSS version 23.0, whereas semi-structured questionnaire was used for in-depth interviews. Binary logistic regression and thematic analysis were employed for quantitative and qualitative data respectively. ResultsMembership renewal of the community was 67.3%. Family size (AOR=2.54; 95%CI: 1.26-5.12), knowledge (AOR=1.87; 95%CI: 1.05-3.32), years of enrollment (AOR=2.22; 95%CI: 1.39-3.54), enrollment fee contributor (AOR=9.16; 95%CI: 5.29-15.82), benefit packages (AOR=1.99; 95%CI: 1.18-3.35), trust in CBHI scheme (AOR=3.53; 95%CI: 2.12-5.86), training (AOR=1.81; 95%CI 1.01-3.21), chronic illness (AOR=6.82; 95%CI: 3.80-12.24) and having children under five (AOR=1.98; 95%CI: 1.27-3.10) were significantly associated with CBHI membership renewal. Low level of awareness, limited benefit packages, unaffordable premium, poor quality health services, and shortage of supplies were determinant factors for CBHI membership renewal. ConclusionCBHI membership renewal was low. Family size, knowledge, years of enrollment, enrollment fee contributor, benefits packages, trust in CBHI scheme, training, chronic illness and having children under five were significantly associated with CBHI membership renewal. In addition, there are correctable gaps in community awareness, benefit packages, affordable premiums, quality health services, and availability of supplies. Hence, necessary measures at all levels must be taken to reduce dropouts from membership.