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Health Insurance Coverage and Its Associated Factors Among Reproductive-Age Women in East Africa: A Multilevel Mixed-Effects Generalized Linear Model
Authors: Adisu Birhanu Weldesenbet, Sewnet Adem Kebede, Behailu Hawulte Ayele, and Biruk Shalmeno Tusa
Source: ClinicoEconomics and Outcomes Research, Volume 13; DOI:
Topic(s): Health care utilization
Health equity
Women's health
Country: Africa
  Multiple African Countries
Published: JUL 2021
Abstract: Background: Despite improvement in access to modern healthcare services in East African countries, health-service delivery and health status of the population remained poor mainly due to the weak health-sector financing system. Therefore, the current study aimed to assess the health insurance coverage and its associated factors among reproductive-age group (RAG) women in East Africa. Methods: The most recent (between 2010 and 2018) Demographic and Health Surveys (DHS) data of the ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe) were included. STATA version 16.0 statistical software was used for data processing and analysis. In the multilevel mixed-effects generalized linear model, variables with a p-value = 0.05 were declared as significant associated factors of health insurance coverage. Results: The overall health insurance coverage in East Africa was 7.56% (95% CI: 7.42%, 7.77%). The odds of health insurance coverage were high among educated, currently working, and rich RAG women whereas it was low among rural residents. Besides, RAG women who have media exposure, visited by field workers, and visited health facilities have a higher chance of health insurance coverage. Conclusion: Health insurance coverage in East Africa among RAG women was below ten percent. Educational status, working status, place of residence, wealth index, media exposure, visiting health facility within 12 months and being visited by field worker were significantly associated with health insurance coverage among RAG women in East Africa. Improving women’s access to health facilities, promoting field workers’ visit, and media exposure targeting uneducated, unemployed, and rural resident women of RAG will be a gateway to promote health insurance coverage.