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Culture Shock Becomes Cultural Synergy: Community Based Healthcare in Ethiopia

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Maggie Callahan
November 6, 2019

In Ethiopia, utilization of healthcare services remains as low as .36 contacts per person. The Ethiopian government has adopted a Community Based Health Insurance (CBHI) initiative to increase access to and utilization of healthcare services throughout the country. The CBHI initiative was adopted as a means for families to have access to the finances requisite for healthcare, which would increase the propensity of families to seek medical care at modern facilities.

Though community-based financial systems have become a primary way of financing healthcare in several developing countries, Ethiopia’s experience with this system has deep historical roots. This community financial system originates with the Idir, which was a long-term traditional financial institution set up by community members to help sustain local finances and raise funds for emergency situations. The funds in the Idir were primarily used to cover the costs that would be borne by a family in the event of a sudden death and the ensuing funeral costs.

The CBHI slightly modifies the traditional Idir by attempting to stop the emergency before it begins through preventative healthcare measures. This process turns the money into live saving funds instead of funeral funds.

In 2011, the CBHI launched across 13 districts within the four main regions of Ethiopia. Prior to the introduction of the CBHI, the Federal Ministry of Health constructed modern, technologically advanced health facilities and began intensive training for healthcare professionals. Though these modern facilities were open, they were seldom used by Ethiopians because of the prohibitive costs associated with medical treatment. The CBHI attempted to fill this financial void and grant deeper access to these new, improved healthcare facilities.

The community finances the CBHI through individual premiums and a 25% subsidy from the government. These funds are collected by kebele representatives who send payments to woreda head offices which reimburse hospitals and health centers for services provided. Households apply to participate and receive cards allowing them to obtain treatment from local facilities without paying up front. Kebele officials screen and select the households that apply and the poorest among them receive an extra 10% of the government subsidy.

The community serves as an oversight board for the CBHI system and plays a role in the setup, governance, and management of the funds and resources. The community monitors the CBHI system through score cards, interviews and surveys. This process empowers the local community through its transparency and accountability measures and increases local coordination with the national government in the process. The community now has access to participation channels and healthcare.

Often aid programs are designed by foreigners, and their methods and practices create a culture shock that makes the programming ineffective or misunderstood by the population. Ethiopia’s CBHI system highlights how impactful cultural synergy can be in creating positive outcomes. Instead of looking outward for solutions, taking stock of local culture and identifying how a local culture can be utilized to solve local problems may prove more effective than foreign methods.

To learn more about this case visit https://participedia.net/case/4958. To read about other innovative applications of public participation, visit www.participedia.net


Author: Maggie Callahan biography: Maggie Callahan is a master’s student of public diplomacy at Syracuse University and a graduate assistant for the Participedia Project at the Maxwell School of Citizenship and Public Affairs. She holds a bachelor’s in political science and economics from Mercer University and has worked in Georgian, Moroccan and Nepalese nongovernmental organizations and the American government. Follow her on Twitter: @laissezmaggie

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