Community-based health insurance reaches few Ethiopian households, national survey finds

Enrollment in Ethiopia’s community-based health insurance (CBHI) scheme remains far below the country’s national target of 80%, according to an analysis of the national health equity survey conducted in 2022/23, with data analysis carried out in June 2025. The cross-sectional study, published in Cost Effectiveness and Resource Allocation, found substantial regional variation in coverage: household enrollment ranged from 5.3% in the Ethiopian Somali region to 69.1% in the Amhara region.

Beyond the regional gaps, the study also documented differences between rural and urban households in CBHI enrollment. Rural households were more likely to be enrolled in the scheme, and several household characteristics were associated with enrollment, including being a housewife or farmer and having five or more children.

Economic and household assets also appeared in the analysis. Households that held bank accounts or microfinance savings accounts were more likely to be enrolled in CBHI, as were households that owned a television. These factors were identified as being associated with higher enrollment rates in the program.

The authors conclude that the Ministry of Health, regional health bureaus, district health offices and CBHI focal units across the country should develop strategies to increase household enrollment into the CBHI program, while also establishing mechanisms to reduce the regional disparities observed in the data.

As a cross-sectional analysis of a single national survey, the study identifies associations between household characteristics and enrollment rather than establishing causal effects, and the reported figures reflect the 2022/23 survey period. The findings nonetheless provide a national snapshot of where CBHI coverage stands relative to Ethiopia’s 80% target, highlighting both the wide regional spread in enrollment and the household-level factors linked to participation in the scheme.

Subject of Research: Household enrollment in community-based health insurance in Ethiopia and its associated factors

Article Title: Household enrollment rate in community-based health insurance and factors associated with it in Ethiopia: analysis from national health equity survey data of 2022/23

Article References: Ararso, D., Zeru, A., Getachew, T., Tiru, G., Alemayehu, S., Tadele, W., Getnet, T., Taye, G., Tadele, A., Dagne, T., Fekadu, L., Shibiru, Y., Achamyelew, H., Tesfaye, H., Kebede, M., Abebe, Y., Atnafu, A., Chala, T. K., Siraj, E., … Tollera, G. (2026). Household enrollment rate in community-based health insurance and factors associated with it in Ethiopia: analysis from national health equity survey data of 2022/23. Cost Effectiveness and Resource Allocation. https://doi.org/10.1186/s12962-026-00840-y

Image Credits: AI Generated

DOI: 10.1186/s12962-026-00840-y

Keywords: Ethiopia, community-based health insurance, health equity survey, enrollment rate, regional disparity, rural households, health financing, universal health coverage, Household, enrollment, rate, community-based