| Abstract: | The study on Effectiveness of Community Based Micro Health Insurance Scheme attached with Women Self Help GROUP (SHG) approach is conducted as a case study on Micro Heath Insurance Scheme piloted in Jimma Town of Oromia National Regional State in Ethiopia. The main Objective of the Pilot
project is to promote community based risk sharing approach on risks related to
health through mutual support and self help. The project aimed to enhance the
health knowledge of the community and capacity to cope when there is heath
risks among the poor women and their children. Protection aspect of health,
such as education, environmental and personnel hygiene, as well as home
management skills are among the basic activities of this project beyond its
promotion of curative aspect of the community based Micro Health Insurance
Scheme.
This Community Based Micro Health insurance Scheme attached with the Self
Help Group approach is implemented in Jimma Town, which is about 315KM
away from the Capital City of Ethiopia, Addis Ababa. According to the year 2007
statistical abstract of CSA, the population of Jimma town is estimated to be
120,600 of which female population accounts for 60,011. The rate of population
growth is 2.9%, which is higher than the national average of 2.6 %. The female
headed families' accounts to 37% of the total households. Its altitude, average
annual rainfall and temperature of the area are 1740 meters above sea level,
1533.6 mm and 29.2 degree Celsius respectively. Jimma is one of coffee
marketing center in Ethiopia. In the town there are about 1060 women organized
under 91SHG (primary level), 15 CLA (secondary level and where MHIS is
managed) and a Federation (tertiary level which represent women at the Town
level).
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The overall objective of the study was to assess the effectiveness of Community
Based Micro Health Insurance scheme attached with the SHG approach. It
assess the impact of the scheme in reducing risks related to health, in promoting
health education and protection and financial, managerial, and structural
feasibility of the scheme.
The specific objectives of the study were to analyze the situation of the poor in
accessing health care services, to study the effectiveness of the pilot community
health insurance scheme attached with women SHG approach and to identify the
opportunities and challenges of MHIS attached with women SHG approach.
Therefore the study assesses health service accessibility of the poor by
comparing accessibility before and after joining SHG. Accessibility to health
service was assessed in relation to health education, information and medical
care. In addition the study assesses the effectiveness of the MHI scheme in
solving problems related to health service access. In this regard also access to
education, information, and finance to get the service were considered.
Moreover, the study tried to assess the opportunities and challenges in relation to
the CBMHIS implemented attached with the SHG approach.
The main tools of data collection were employing structured questionnaire to
interview individual sample members of the MHIS, FGD and secondary data
review. FGD was implemented to gather information from the CLAs MHIS subcommittees
and basic information collected based on a guiding question. Cases
of non-MHIS members were also considered in the information collection process
through conducting sample interview with open ended question. Secondary data
was used as another source of information for the study. Local data from the
implementing organization and the CLAs themselves, National policies, studies,
and guidelines related to health and health financing, international reports,
studies and experiences regarding health and poverty, health insurance and
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community based health insurance strategies reviewed in the literature review
part of this study.
The Findings of the study had indicated that poor women have got access to
health information, education and coverage of risks related to health which they
didn’t have or have limited before joining SHG and MHIS. Awareness of women
and their families on applying health protection skills enhanced. Their MHIS
started to cover some part of their medical expense as per the developed by-law
which encourages them to build trust on their self help and mutual support.
It is also found that the SHG approach is a very good structure in promoting the
Community Based MHIS. The SHG approach promotes the enhancement of poor
women to unleash their potential and start helping themselves and others to get
out of poverty. This self help and mutual support attitude built in the SHG
approach was a spring board for successful start of the MHIS. Women with their
families became members of the MHIS and contribute money per month per
individual.
There were some challenges and obstacles of the scheme. Long distance
between the Members and the management of the MHIS created problems in
transparency of information and procedures of claim settlement. Unable to meet
regularly and take long time to settle the claim was among the challenges in the
scheme. Moreover, since community based initiatives are mostly managed by
the volunteer members, sub-committees, it was not taken as a serious business
and this is one of the reason for the long procedure of settling claims. In addition
the study finding indicated that MHIS needs skills in insurance management,
finical management, linkage and networking and sensitization, which in turn is
found very poor during the assessment. |
