Community-Based Health Insurance Program Makes Family Healthcare More Affordable and Accessible in Ethiopia

Amnur Hassen is a father of six from the Oromia region of Ethiopia who suffers from chronic illness. He supports his family by growing potatoes and raising cattle to sell at a nearby market, but his profits were often cancelled out by the frequently incurred costs of his medical treatments, leaving Amnur struggling to provide for his family.

In Ethiopia, many families lack access to health insurance, resulting in large out-of-pocket expenses for healthcare that is often too expensive for poor families to afford. USAID has been working with the Government of Ethiopia to scale up a community-based health insurance system to make healthcare more accessible and more affordable across the country. Through this initiative, Amnur and his family pay an annual fee of 180 Ethiopian birr – or approximately USD $7 – and receive healthcare services by showing their membership card when they visit their local health facility.

At first, he had doubts that this insurance program would work and was hesitant to enroll. However, after several others from his village joined, Amnur went to the local government administration office and registered. Little did he know that this simple transaction could save his life.

Several months later, Amnur became critically ill. Worried about the potential cost, Amnur refused medical treatment despite being covered by insurance and his condition continued to deteriorate to the point where his wife and relatives were worried for his life. They carried him to a nearby hospital where Amnur received emergency surgery.

Eight days later, despite a successful recovery, Amnur was still anxious and asked his wife Ferdosa how much money they owed for the procedure. When he learned that the total costs amounted to more than 12,000 birr (approximately USD $450), Amnur’s anxiety increased exponentially because he knew that he only had a savings of 5,000 birr.

“Don’t worry,” explained Ferdosa. “All the money has already been paid.”

Confused, Amnur replied, “Who paid for me? Which relative?”

Ferdosa told Amnur that, thanks to their community-based health insurance, all of the medical expenses were covered under the program.

Amnur was relieved and exclaimed “I did not know the health insurance that I joined was closer than a relative.”

Upon his recovery, Amnur invested his savings of 5,000 birr – money he thought was lost to medical bills – to buy two goats and an ox, helping him expand his livestock operation. Amnur proudly explained, “Health insurance has not only improved my health and the health of my family, but also – unexpectedly – my livelihood.”

Over the past five years, more than 60,000 individuals in Amnur’s district of Deder have enrolled in the community-based health insurance program, reducing their reliance on out-of-pocket health expenses and increasing their ability to overcome routine and life-threatening illnesses alike.

USAID is supporting the Ethiopian government in its efforts to expand community-based health insurance coverage to reach 80 percent of the eligible population in 80 percent of the country’s districts. So far, nearly 20 million people in now Ethiopia have health insurance coverage through the community-based health insurance program. Each year, approximately 75 percent of the insurance program members re-enroll in the program and benefit from the financial protection it provides.