The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. OBJECTIVE: We evaluated the impact of Ethiopia's community-based health insurance (2012-2021) on universal health coverage. METHODS: On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. RESULTS: The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44-2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29-2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27-19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12-16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50-1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41-1.02). CONCLUSION: Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.

Herbal medicines use and associated factors among pregnant women in Debre Tabor town, north West Ethiopia: a mixed method approach.

BACKGROUND: Use of herbal medicines during pregnancy has been increase in many developing and developed countries. In spite of the studies done on herbal medicine, no study has addressed use of herbal medicine among pregnant women in Debre Tabor Town. Hence, the major aim of this study was to assess the prevalence of herbal medicine use and associated factors. METHODS: A community based explanatory sequential mixed methods was employed. The quantitative method used cross-sectional study design with a sample size of 267 women, also 12 participants in a group for focus group discussion and 6 in-depth interviews from focus group were included for a qualitative part using a purposive sampling technique. The data were coded and entered into Epidata 4.2.0.0 and analysis was done using SPSS version 25, while thematic analysis was used for qualitative data. Bivariate and multivariate logistic analyses were used to assess associations between dependent and independent variables. RESULTS: Ninety-five (36.3%) of pregnant women used herbal medicine during pregnancy. Prior use of herbal medicine (AOR: 3.138; 95% CI: 1.375, 7.162), unable to read & write (AOR: 9.316; 95% CI: 2.339, 37.101), presence of health problems (AOR: 3.263; 95% CI: 1.502, 7.090), drug availability (AOR: 9.872; 95% CI: 4.322, 22.551) and distance to the health facilities (AOR 6.153; 95% CI 2.487, 15.226) were significantly associated with use of herbal medicine. Only 5(5.3%) of herbal medicine users disclosed their herbal medicine use to their healthcare providers. Zingiber officinale, Eucalyptus globulus, Rutachalepensis, Linumusitatissimum, and Moringa stenopetala were the most commonly used herbal medicines by pregnant women. CONCLUSIONS: The use of herbal medicine during pregnancy is a common practice and significantly associated with educational status, prior use of herbal medicine, presence of health problems, drug availability and distance to the health facilities. Since there was high prevalence and low disclosure rate of herbal medicine use, it should be ensured that physicians/midwives establish a good level of communication with pregnant women.

Religion, Spirits, Human Agents and Healing: A Conceptual Understanding from a Sociocultural Study of Tehuledere Community, Northeastern Ethiopia.

This paper explores the relationship among religion, spirits and healing in the Tehuledere community in the northeastern part of Ethiopia and focuses on how this knowledge can inform primary healthcare reform. The study employed qualitative ethnographic methods. Participatory observation, over a total of 5 months during the span of 1 year, was supplemented by focus group discussions (96 participants in 10 groups) and in-depth interviews (n = 20) conducted with key informants. Data were analyzed thematically using narrative strategies. The present study revealed that members of the study community perceive health, illness and healing as being given by God. Many of the Tehuledere people attribute illness to the wrath of supernatural forces. Healing is thought to be mitigated by divine assistance obtained through supplication and rituals and through the healing interventions of nature spirit actors. We found that the health, illnesses and healing were inextricably linked to religious and spiritual beliefs. Our findings suggest that religious and spiritual elements should be considered when drafting and implementing primary healthcare strategies for the study communities and similar environments and populations around the globe.