East African Journal of Applied Health Evaluation Issue 4 | March 2020 East African Journal of Applied Health Monitoring and Evaluation ISSN 2591 - 6769 EDITORIAL BOARD CO-CHIEF EDITORS Henry Mollel, MSc, PhD (Mzumbe University, Tanzania) Debbie Bain Brickley, MPH, DrPH (University of California, San Francisco) MANUSCRIPT EDITOR Mackfallen Anasel, MSc, PhD (Mzumbe University) WEB EDITOR Christen Said, MPH (University of California, San Francisco) EDITORIAL BOARD Andrew Abaasa, MSc (MRC/UVRI Uganda Research Unit on AIDS) Mackfallen Anasel, PhD, MSc (Mzumbe University, Tanzania) Gershim Asiki, MBChB, MSc, PhD (African Population & Health Research Center, Kenya) Etienne Karita, MD, MSc, MSPH (Projet San Francisco, Rwanda) Claud Kumalija, MSc (Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania) Bunini Manyilizu, MD, MPH, MBA, PhD (Mzumbe University, Tanzania) Lawrencia Mushi, BHSM, MSc.UMD, PhD (Mzumbe University, Tanzania) Roger Myrick, PhD, MA (University of California, San Francisco) Gloria Omosa-Manyonyi, MBChB, MSc (University of Nairobi) George Rutherford, MD, MA (University of California, San Francisco) Jim Todd, MA, MSc (London School of Hygiene and Tropical Medicine) EDITORIAL ASSISTANTS Sandra Dratler, DrPH (University of California, Berkeley) Susie Welty, MPH (University of California, San Francisco) Karen White, MBA, MPH (University of California, San Francisco) DESIGN & LAYOUT Mackfallen Anasel (Mzumbe University) Cover photo by Rose J. Mdami Address all editorial correspondence to Email: [email protected] Website: http://eajahme.com Copyright 2020 All rights reserved. Disclaimer: No part of this publication may be reproduced, stored or transmitted in any form or by any means (electronic or otherwise) without prior permission, in writing, of East African Journal of Applied Health Monitoring and Evaluation. Individual authors are responsible for the content of their articles. Table of Contents RESEARCH ARTICLES Factors Associated with Willingness to Pay for Social Health Insurance among 1 Government Employees in Tigrai Region, Northern Ethiopia Ataklti T. Gessesse, Abera A. Berhe, Mulugeta G. Tilahun, Tesfay W. Teklemariam Knowledge of HIV status among mothers accompanying their infants for immunization 7 in Machakos, Kenya, 2014 Lilly M. Nyagah, Elvis Kirui, Peter W. Young, Joseph Gikunju, Jane Githuku, Sara Lowther, Andrea A. Kim Trend and predictors for early infant diagnosis by PCR among HIV-exposed infants in 13 Dar es Salaam region, Tanzania, 2014-2016 Michael F. Mboya, Prosper Njau, Jim Todd, Beatrice John Lerayo, Goodluck Wiley Lyatuu, Lameck Machumi, Sia E. Msuya, Michael J. Mahande, Jenny Renju Ocular symptoms and associated factors among hairdressers in Kinondoni Municipality, 22 Dar es Salaam, Tanzania Olirk Baldwina Tita, Ezra Jonathan Mrema1, Simon Mamuya Knowledge, attitudes, perceptions and acceptability of Onchocerciasis control through 28 community-directed Treatment with Ivermectin: implications for persistent Transmission in Ulanga district, Tanzania Vivian Mushi, Deodatus Kakoko, Donath Tarimo Research Article 2020; Issue 4 ISSN 2591 – 6769 Factors Associated with Willingness to Pay for Social Health Insurance among Government Employees in Tigrai Region, Northern Ethiopia Ataklti T. Gessesse1, Abera A. Berhe2, Mulugeta G. Tilahun1, Tesfay W. Teklemariam1 1. Health researcher, Tigrai health research institute, Mekelle, Tigrai, Ethiopia 2. Department of Biostatistics, College health science, Mekelle University, Tigrai, Ethiopia Correspondence to: Ataklti T. Gessesse; Tel: +251914002439; Email: [email protected]; PO Box 1547; Mekelle, Tigrai, Ethiopia INTRODUCTION Developing countries seldom use social health insurance (SHI), and their healthcare finances mostly rely on general revenues and direct out-of-pocket payments. This study investigated the level and factors associated with willingness to pay for SHI among government employees in Tigrai region, North Ethiopia. METHODS An institution-based quantitative cross-sectional study was carried out from June to July 2018 among government employees in Tigrai, Ethiopia. Sample size was determined using single population proportion formula, and multi-stage cluster sampling was used to select the study participants. Data collected using an interviewer-administered questionnaire was analyzed using SPSS Version 20. RESULTS There were 544 (64.5%) respondents who were not willing to pay for SHI. Respondents age older than 39 years were 2.2 times more likely to be willing to pay for SHI, as were those who disagreed with the binding rule of referral system (1.4 times), and with exclusion of periodic medical checkup from the SHI (1.4 times), those who didn’t consider health service quality to be poor (1.6 times), and those who disagreed with the presence of financial insecurity in health institutions (1.7 times). CONCLUSION This study revealed that government employees’ willingness to pay for SHI was low. SHI agencies should publicize the proclamation for SHI and induce employees with SHI referral system, services excluded, and health facilities’ readiness and service quality to increase willingness to pay. In addition, the government should reconsider the implementation of the proclamation for SHI accordingly. Key words: employee, willingness to pay, social health insurance INTRODUCTION On the other hand, poor populations in sub-Saharan Africa Globally, high proportions of people suffer and die due to make up approximately 24% of the global disease burden and lack of access to basic healthcare services. Each year in low- account for less than 1% of global health expenditures and middle-income countries, approximately 150 million (Bank.,W., 2011). Similarly, the recent Ethiopian health people suffer a health-related financial catastrophe, and more account showed that the share of total government health than three people are pushed into poverty per second as a spending was not more than 5.6% of the total government result of out-of-pocket (OOP) health expenditures (Bump J, expenditure, and around 34% of this expenditure comes from et al., 2016, Averill C et al., 2013). This signifies that health OOP payment of households (Federal ministry of health service fees are a main barrier to healthcare coverage and [FMoH], 2014). utilization (Dieleman JL et al., 2017). Moreover, many SHI is an agreement that insures individuals from damage, African countries fail to attain the minimum 15% of their illness and death, and transfers risk of an individual's loss budget allocation for health (Spreeuwers, A.M. et al., 2012), (Comfort AB, et al., 2013) by pooling risks with other people which was agreed on through the Abuja Declaration of 2001. (Comfort AB et al., 2013, De Allegri M, et al.,2006). To 1 Research Article East African Journal of Applied Health Monitoring and Evaluation 2 reduce reliance on direct OOP payments and achieve describe selected study variables. Bivariable logistic universal health coverage (UHC), governments encourage regression at p-value <0.2 and multivariate logistic implementation of health insurance schemes (Odeyemi IA., regression at p-value <0.05 was performed to identify the 2014). Several countries have started SHI as the country's factors associated with employees’ willingness to pay for the system of healthcare financing and have attained UHC scheme using odds ratios (OR) at 95% CI. (Carrin G, et al., 2005). However, low- and middle-income countries seldom use SHI and mostly rely on general All procedures performed in this study were in accordance revenues and direct OOP payments as sources of healthcare with the ethical standards of the institutional and national financing (Hsiao W.C & Shaw. R.P). As of 2008, Ethiopia research committee and with the 1964 Helsinki Declaration had only 1.1% of any kind of insurance with 1% of and its later amendments or comparable ethical standards. government health expenditures spent on insurance activities Participants were not provided with any incentives or (FMoH, 2008). payment to take part in the study and were given the full right Even though Ethiopia is preparing to start SHI, to refuse from participating or to withdraw from the study at willingness to pay for the scheme is not well researched any time. Ethical clearance was obtained from Tigrai Health (Agago TA et al., 2014, MoH,2010). Studies have been Research Institute Institutional Review Board, and an official limited to a particular facility and city with small sample support letter was obtained from Tigrai Regional Health sizes. This study aims to investigate the level and factors Bureau. Consent was obtained from each study participant, associated with willingness to pay among government and confidentiality of data and scientific honesty was employees in Tigrai, which can help individuals to make maintained. informed choices and provide evidence for policymakers and program implementers to set equitable level of premiums. RESULTS Socio-demographic characteristics METHOD A total of 843 government employees participated in the The study used an institution-based quantitative cross- study. More than half of the respondents (432; 51.2%) were sectional study design carried out from June to July 2018 male, and 439 (52.1%) had 1-3 family members. The mean among government employees in Tigrai region, North age of the respondents was 35 years. More than half (466; Ethiopia. Sample size was determined using single 55.3%) of the respondents were less than 35 years of age and population proportion formula