Community-Based Health Insurance in Ethiopia is Changing Health Seeking Behaviour Among the Insured
Download DocumentDeep Dive Overview
The Community-Based Health Insurance (CBHI) reform in Ethiopia is a strategic healthcare financing initiative introduced in 2011 to transition Ethiopia away from a system heavily reliant on high out-of-pocket (OOP) payments and toward a sustainable, domestic resource-based model. The initiative was first launched as a pilot in 2011, and following its success, the government began rapid nationwide scale-up in 2015. By 2020, the program had reached more than 80% of all woredas (districts).
Before the implementation of CBHI, Ethiopia's per capita health spending remained at approximately $33.20 — significantly lower than the WHO-recommended $86 per person for low-income countries. OOP healthcare payments exceeded the recommended 15–20% threshold. Most citizens in the informal sector, including 78.3% of the population living in rural areas engaged in subsistence farming, had no financial protection against health shocks.
Policy Recommendations
Policies should consider complementary measures, such as improving the geographic proximity of facilities, to mitigate non-medical barriers to care
Policymakers should use insurance to move toward the WHO-recommended threshold of keeping OOP payments below 15–20% of total health expenditure
To ensure health equity, governments should provide full financial support for those unable to pay premiums
African Union member states should design insurance schemes that take into account the informal and rural sectors
Key Numbers
of Ethiopian districts reached by 2020
households surveyed in study
catastrophic expenditure rate for CBHI members
lower OOP costs for insured members
Deep Dive Summary
An analysis of the nationwide scale-up of community-based health insurance (CBHI) in Ethiopia, demonstrating how removing financial barriers has increased service utilisation and significantly reduced catastrophic health expenditures.
Content Type
Case Study
Region
Eastern Africa
Author
Research Team
Read Time
10 min
Key Findings
CBHI membership encouraged proactive health-seeking behaviour, enabling earlier care-seeking and diagnosis before conditions became severe.
CBHI members experienced a significantly lower rate of catastrophic health expenditure, remaining the only group below the 10% threshold.
Total out-of-pocket payments for CBHI members were roughly half of those in non-CBHI districts.
Non-members in CBHI districts were nearly twice as likely to cite 'lack of money' as a barrier to seeking care compared to insured members.