Willingness to join a village-based health insurance scheme (Iddir) in Dessie town, Ethiopia


Abstract Introduction: The total health spending in Ethiopia (both public and private) is still limited and compromises purchase of desired healthcare. There has recently been an increase in interest in health insurance as a promising approach to healthcare financing reform in Ethiopia. Iddirs (indigenous community self-help institutions) appear to have good management practices and are successful in mobilizing communities. This study aimed to estimate the prevalence of the willingness of people in Dessie town, Northeast Ethiopia, to join an iddir-based health insurance scheme, and to identify factors associated with this prevalence. Methods: A cross-sectional study was conducted from February to March 2016 in Dessie town; 636 participants were recruited during that period. Multi-stage sampling was used to select informants and data were collected using face-to-face interviews. Both bivariable and multivariable logistic regressions were used to model the odds of willingness to participate in iddirs. Results: The proportion of people who were willing to join an Iiddir-based health insurance scheme was 83.2%. In terms of willingness to join the health insurance scheme, the odds were likely to be significantly higher among those who attended at least primary school education (AOR = 4.91; 95% CI: 2.21-10.8), those who were wealthy (AOR = 3.39; 95% CI: 1.74-6.58), and those whose family size was greater or equal to five (AOR = 3.42; 95% CI: 2.44-5.15). Being single decreases the willingness to join Iddir-based health Insurance scheme (AOR = 0.29; 95% CI: 0.14-0.55). Conclusion: Iddir association initiated health insurance scheme and considered the possible alternative source of finance for healthcare. The prevalence of willingness to join an iddir-based health insurance scheme was high. Thus, it is recommended to align insurance strategies with the scope of iddirs in order to mobilize the community for sustainable resources generation as an alternative source of finance for healthcare.  [Ethiop. J. Health Dev. 2018;32(4):249-256] Key words: Health insurance, Iddir, Insurance, Dessie, Ethiopia