Determinants of Community-Based Health Insurance Scheme Enrolment in Developing Countries: A Systematic Review

In developing Nations, the Community-based Health Insurance (CBHI) scheme is a potential approach to increasing access to quality healthcare. It has the potency of generating financial resources for health services; plus improve on the standard of life of the people. Evidence based reports suggest that enrolment into the CBHI is still low, particularly among low income earners of the third world nations. Thus, this study was undertaken to review and help formulate policies by existential evidence on the factors that determines enrolment into the CBHI in developing countries. Study adopted the thematic synthesis of both qualitative and mixed method studies that report the above measure of interest. Study relied on Ovid Medline In-Process and other Non-Indexed citations till present. Study sourced the web of Knowledge, Google Scholar for articles relating to enrolment into CBHI in developing countries. Six studies (qualitative and mixed method studies) reporting qualitative results on the factors determining enrolment into CBHI in developing countries met the inclusion criteria. Quality assessment was carried out on each study and findings were synthesised with the aid of thematic synthesis. Four major themes were identified by interpreting and categorizing the themes across all selected studies; Individual factors, Scheme factors, Service provider factors and Requirement to team up with others before enrolment. In the end, study observed enrolment into CBHI scheme in developing countries to be driven by several factors including age and policy making, most of which positively or negatively influence decisions made by households to enrol or not in the CBHI scheme. Findings from this review are expected to contribute to policy and decision making for health care centres under CBHI scheme in developing countries.