The Study on Effectiveness of Community Based Micro Health Insurance Scheme attached with Women Self Help GROUP (SHG) approach in Ethiopia: the Case of Jimma Town Women SHGs

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). 2 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 3 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.