Feasibility and Desirability of Scaling up Community –based Health Insurance (CBHI) in rural communities in Uganda. Lessons from Kisiizi hospital CBHI scheme.

Abstract Background Community-based health Insurance (CBHI) schemes have promoted equitable healthcare access and raised additional revenue for health sector, in addition to forming foundations for National Health Insurance schemes in many countries. Non-profit making organisations characterised by solidarity, voluntary membership and prepayment for health care. Kisiizi hospital CBHI scheme has 41,500 registered members since 1996, organised in 210 community associations known as ‘Bataka’ or ‘Engozi’ societies. Members pay annual premium fees and a co-payment fee before service utilisation. This Study aimed at exploring the feasibility and desirability of scaling up CBHI in Rubabo County, with objectives of; exploring community perceptions and determining acceptability of CBHI, identifying barriers and enablers to scaling up CBHI and documenting lessons regarding CBHI expansion in a rural community. Method: Descriptive study using qualitative methods. Key informant interviews and Focus Group Discussions (FGD) were used in data collection. Participants were selected from three villages with differing levels of insurance coverage. Twenty two key informant interviews were conducted using semi-structured questionnaires. Three FGD for scheme members and three for non-scheme members were conducted. Data was analysed using thematic approach. Results: Scaling up Kisiizi hospital CBHI is desirable because; it conforms to the national social protection agenda, conforms to society values, offers a comprehensive benefits package, and is a better healthcare financing alternative for many households. Secondly, scaling up Kisiizi hospital CBHI is largely feasible since a strong network of community associations exist, trusted quality of services at Kisiizi Hospital, affordable fees, and trusted leadership and management systems. However, scale up of the Kisiizi hospital CBHI is still limited by; long distances and high transport costs to Kisiizi hospital, low levels of knowledge about insurance, overlapping financial priorities at household level and inability of some households to pay insurance fees. Conclusions CBHI scheme implementation requires the following considerations; Conformity with local society values, conformity with national policies/guidelines, a comprehensive benefits package, trusted quality of healthcare services, affordable fees, and trusted leadership and management systems. Key words Community-based Health Insurance, Universal Health Coverage, Health financing, Enrolment