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Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review

Overview of attention for article published in International Journal for Equity in Health, January 2018
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (94th percentile)
  • High Attention Score compared to outputs of the same age and source (91st percentile)

Mentioned by

blogs
1 blog
twitter
53 X users

Citations

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93 Dimensions

Readers on

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556 Mendeley
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Title
Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review
Published in
International Journal for Equity in Health, January 2018
DOI 10.1186/s12939-018-0721-4
Pubmed ID
Authors

Racha Fadlallah, Fadi El-Jardali, Nour Hemadi, Rami Z. Morsi, Clara Abou Abou Samra, Ali Ahmad, Khurram Arif, Lama Hishi, Gladys Honein-AbouHaidar, Elie A. Akl

Abstract

Community-based health insurance (CBHI) has evolved as an alternative health financing mechanism to out of pocket payments in low- and middle-income countries (LMICs), particularly in areas where government or employer-based health insurance is minimal. This systematic review aimed to assess the barriers and facilitators to implementation, uptake and sustainability of CHBI schemes in LMICs. We searched six electronic databases and grey literature. We included both quantitative and qualitative studies written in English language and published after year 1992. Two reviewers worked in duplicate and independently to complete study selection, data abstraction, and assessment of methodological features. We synthesized the findings based on thematic analysis and categorized according to the ecological model into individual, interpersonal, community and systems levels. Of 15,510 citations, 51 met the eligibility criteria. Individual factors included awareness and understanding of the concept of CBHI, trust in scheme and scheme managers, perceived service quality, and demographic characteristics, which influenced enrollment and sustainability. Interpersonal factors such as household dynamics, other family members enrolled in the scheme, and social solidarity influenced enrollment and renewal of membership. Community-level factors such as culture and community involvement in scheme development influenced enrollment and sustainability of scheme. Systems-level factors encompassed governance, financial and delivery arrangement. Government involvement, accountability of scheme management, and strong policymaker-implementer relation facilitated implementation and sustainability of scheme. Packages that covered outpatient and inpatient care and those tailored to community needs contributed to increased enrollment. Amount and timing of premium collection was reported to negatively influence enrollment while factors reported as threats to sustainability included facility bankruptcy, operating on small budgets, rising healthcare costs, small risk pool, irregular contributions, and overutilization of services. At the delivery level, accessibility of facilities, facility environment, and health personnel influenced enrollment, service utilization and dropout rates. There are a multitude of interrelated factors at the individual, interpersonal, community and systems levels that drive the implementation, uptake and sustainability of CBHI schemes. We discuss the implications of the findings at the policy and research level. The review protocol is registered in PROSPERO International prospective register of systematic reviews (ID =  CRD42015019812 ).

X Demographics

X Demographics

The data shown below were collected from the profiles of 53 X users who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 556 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 556 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 102 18%
Researcher 44 8%
Student > Ph. D. Student 41 7%
Unspecified 36 6%
Student > Postgraduate 33 6%
Other 101 18%
Unknown 199 36%
Readers by discipline Count As %
Medicine and Dentistry 73 13%
Nursing and Health Professions 60 11%
Social Sciences 55 10%
Unspecified 35 6%
Business, Management and Accounting 28 5%
Other 89 16%
Unknown 216 39%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 40. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 October 2018.
All research outputs
#945,161
of 24,127,528 outputs
Outputs from International Journal for Equity in Health
#113
of 2,048 outputs
Outputs of similar age
#23,496
of 449,011 outputs
Outputs of similar age from International Journal for Equity in Health
#4
of 35 outputs
Altmetric has tracked 24,127,528 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 96th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 2,048 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 11.5. This one has done particularly well, scoring higher than 94% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 449,011 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 94% of its contemporaries.
We're also able to compare this research output to 35 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 91% of its contemporaries.