Socio demographic characteristics of the respondents
Regarding educational status, more than half, 405(58.5%) were first degree and above holders and 360(52 %) of them were working in health facilities with mean service year of 9.5 +7.2 SD. From the total respondents, 78(11.3%) had legitimate authority in their working institution. and 33.1% don’t have their own house (table 1).
Table 1: Socio demographic characteristics of the respondents among public servants in Arba Minch town, 2019
Variables
|
Category
|
Frequency(n)
|
Percent (%)
|
Age (years)
|
20-24
|
81
|
11.7
|
25-29
|
251
|
36.3
|
30-34
|
146
|
21.1
|
35-39
|
96
|
13.9
|
>39
|
118
|
17.1
|
Sex
|
Male
|
442
|
63.9
|
Female
|
250
|
36.1
|
Marital Status
|
Single
Married
|
249
443
|
36
64
|
Religion
|
Orthodox
|
386
|
55.8
|
Protestant
|
263
|
38
|
Muslim
|
43
|
6.2
|
Family size
|
1-2
|
276
|
39.9
|
2-4
|
239
|
34.5
|
>4
|
177
|
25.6
|
Educational level
|
Certificate & below
|
71
|
10.3
|
Diploma
|
216
|
31.2
|
Degree & Above
|
405
|
58.5
|
Working institution
|
Health Facility
|
360
|
52
|
College
|
276
|
39.9
|
Town Administration
|
56
|
8.1
|
Service years
|
1-5
|
265
|
38.3
|
5-10
|
217
|
31.4
|
10-15
|
90
|
13.0
|
>15
|
120
|
17.3
|
Net monthly income
|
<4000
|
300
|
43.4
|
4000-6500
|
200
|
28.9
|
>6500
|
192
|
27.7
|
|
|
|
|
Health status and health expenditure
One third of the respondents 236(34.1%) visited modern health facilities for a certain medical care within the past 12 months, of those 122(17.6%) visited public health facilities, and 165 (23.8 %) visited modern health care facilities for less than two times in the recall period. From those who visited modern health facilities, 152 (22%) spend less than 1000 ETB and 220(31.8%) covered their health care expenditure from their OOP, whereas 16 (2.3%) were forced to borrow money from relatives (table 2).
Table 2: Health and health expenditure status of the respondents among public servants in Arba Minch town, 2019
Variables
|
Category
|
Frequency(n)
|
Percent (%)
|
Got sick in the last 1-year
|
Yes
|
236
|
34.1
|
No
|
456
|
65.9
|
Got health care
|
Yes
|
236
|
34.1
|
No
|
456
|
65.9
|
Types of health facilities to get health care
|
Public Health Facility
|
122
|
17.6
|
Private Health Facility
|
73
|
10.5
|
both Public & Private
|
40
|
5.80
|
Frequency of visit to modern health care
|
<2 times
|
165
|
23.8
|
>2 times
|
71
|
10.3
|
ETB* spent for modern health care in the last 1- year
|
<1000
|
152
|
22.0
|
>1000
|
84
|
12.1
|
Covered all from OOP
|
Yes
|
220
|
31.8
|
No
|
16
|
2.30
|
*Ethiopian Birr
|
|
|
|
Awareness and perception of SHI scheme
From the total respondents, 347(50.1 %) reported that they never heard about SHI before the time of data collection. Regarding the knowledge of SHI, more than one third, 270 (39%) knew about the benefit package of the SHI scheme (Table 3).
Table 3: Awareness about SHI scheme among formal public servants in Arba Minch town, 2019
Variables
|
Category
|
Frequency (n)
|
Percent (%)
|
|
|
|
|
Have you heard about SHI
|
Yes
|
345
|
49.9
|
|
No
|
347
|
50.1
|
Knowledge on SHI
|
Benefit package
|
270
|
39
|
Premium contribution
|
68
|
9.8
|
Regularly get health information by mass media
|
Yes
|
379
|
54.8
|
No
|
313
|
45.2
|
Have you participated in any social network?
|
Yes
|
507
|
73.3
|
No
|
185
|
26.7
|
Willingness to join and pay for SHI
About one third, 254 (36.7%) of respondents were willing to join and pay for the newly proposed SHI (Fig 2).
Figure 2: Willingness to join and pay for SHI scheme among public servants in Arba Minch town (n=692)
Among those who don't willing to join and pay for SHI, The main reason for not willing to join and pay for SHI were poor quality public health facility service, small monthly salary, lack of trust on the agency governing the contribution, Preference to use private health facilities and lack of enough information about SHI(Fig 3).
Out of 254 respondents who were willing to join SHI, 171 (24.7%) respondents were willing to pay less than 1% , 42(6.1%) were willing to pay 1-2 % and 41(5.9%) respondents were willing to pay 2-3% of their gross monthly salary per month with mean 1.47% (+ 0.76) monthly gross salary.
Fig.3: Reason for not willing to join and pay for the newly proposed SHI among public servants in Arba Minch town.
Factors associated with willingness to join and pay for the newly proposed SHI
Religion, working sector, family size, history of getting sick in the last 12 months, institution where heath care provided, knowledge about SHI, amount of OOP health care expenditure, regularly getting for health information from mass media and social network participation had significant association with willingness to join and pay for SHI during bivariate analysis. However, awareness of SHI, family size, regularly listening for health information and participation of social network were significantly associated with willingness to join and pay for SHI during multivariate analysis. Public servants who heard about SHI were 2.4 times more likely willing to join and pay for SHI as compared to those who didn’t heard of the scheme (AOR=2.39; 95%; CI, 1.59,3.75). Participants with >4 family size were 52 % more likely to be willing to join and pay for SHI as compared to respondents with family size less than two (AOR=1.52; 95%CI; 1.32, 8.82).
The odds of those who participate in social network were 1.6 times more likely willing to join and pay for SHI as compared to their counterparts(AOR=1.56; 95%CI; 1.04, 2.36). Respondents who regularly follow for health information were 1.5 times more likely willing to join SHI as compared to those who did not follow health information (AOR=1.50; 95%CI; 1.00, 2.27) (Table 4).
Table 4: Determinants of willingness to join and pay for SHI among public servant in Arba Minch town, 2019 (n=692)
Variable
|
Category
|
WTJ
|
NWTJ
|
COR (95%CI)
|
PV
|
AOR(95%CI)
|
PV
|
Religion
|
Orthodox
|
153
|
233
|
1.52(0.76,2.99)
|
0.67
|
0.97(0.46,2.05)
|
0.95
|
Protestant
|
88
|
175
|
1.16(0.57,2.34)
|
011
|
1.12(0.79,1.63)
|
0.52
|
Muslim
|
13
|
30
|
1
|
|
1
|
|
Family Size
|
1-2
|
105
|
171
|
1
|
|
1
|
|
2-4
|
92
|
147
|
1.3(0.87,1.92)
|
0.20
|
0.72(0.48,1.09)
|
0.190
|
>4
|
57
|
120
|
1.32(0.87,1.98)
|
0.18
|
1.52(1.33,7.82)
|
0.011
|
Working Sector
|
Health Facility
|
137
|
223
|
*2(1.027,3.894)
|
0.04
|
1.58(0.78,3.2)
|
0.120
|
College
|
104
|
172
|
*2.032(1.05,3.91)
|
0.03
|
1.35(0.66,2.72)
|
0.402
|
Town Admin
|
13
|
43
|
1
|
|
1
|
|
Do you heard of SHI
|
Yes
|
170
|
175
|
*3(2.2,4.2)
|
0.001
|
*2.3(1.52,3.46)
|
0.001
|
|
No
|
84
|
263
|
1
|
|
1
|
|
Got Sick
|
Yes
|
95
|
141
|
1.25(0.911,1.74)
|
0.16
|
1.57(0.86,2.87)
|
0.140
|
No
|
159
|
297
|
1
|
|
1
|
|
Service preference in last one year
|
Private facility
|
57
|
65
|
0.48(0.23,1.09)
|
0.01
|
0.47(0.20,1.06)
|
0.070
|
Public facility
|
26
|
48
|
0.618(0.341,1.12)
|
0.06
|
0.80(0.42,1.52)
|
0.490
|
Both
|
12
|
28
|
1
|
|
1
|
|
Amount of OOPP
|
<1000
|
58
|
94
|
1
|
|
1
|
|
>1001
|
37
|
47
|
0.68(0.42,1.09)
|
0.10
|
0.75(0.42,1.36)
|
0.351
|
Do you get health info. regularly
|
Yes
|
175
|
204
|
*2.54(1.84,3.52)
|
0.001
|
*1.5(1.08,2.28)
|
0.048
|
No
|
79
|
234
|
1
|
|
1
|
|
Participation in Social network
|
Yes
|
205
|
302
|
*1.88(1.29,2.73)
|
0.001
|
*1.54(1.01,2.35)
|
0.040
|
No
|
49
|
136
|
1
|
|
1
|
|
*statistically significant at P < .05
|