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Health Policy. 2009 Sep;92(1):96-102. doi: 10.1016/j.healthpol.2009.02.007. Epub 2009 Apr 5.

Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria.

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Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria.



To determine how equitable enrolment and utilization of community-based health insurance is in two communities with varying levels of success in implementing the scheme.


The study was undertaken in two communities in Anambra state, southeast Nigeria. Data was collected using a questionnaire that was administered to 971 respondents in two communities selected by simple random sampling. Data analysis examined socio-economic status (SES) differences in enrolment levels, utilization, willingness to renew registration and payments.


Enrolment level was 15.5% in the non-successful community and 48.4% in the successful community (p<0.0001). However, there was no inequity in enrolment, willingness to renew registration and utilization of services. Equal amounts of money were paid as registration fee and premium by all SES quartiles. There were no exemptions and no subsidies.


Enrolment was generally low and contributions were retrogressive. The average premiums were also small. However, there was equitable enrolment and utilization of services. Efforts need to be made to increase the number of enrolees, so as to increase the pool of funds and risks. Payments by enrolees especially in poor and rural communities should be supplemented by subsidies from government and donors in order to ensure equitable financial risk protection.

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