Philipa Mladovsky
Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal
London School of Economics and Political Science
although high level dropout communitybased health insurance cbhi frequently reported rarely analysed depth study explores whether never actively participated cbhi determinant dropout conceptual framework passive active community participation cbhi developed inform quantitative data analysis fieldwork comprising household survey conducted senegal 2009 levels active participation among 382 members exmembers cbhi across three case study schemes compared using logistic regression results suggest controlling range socioeconomic variables active mode participation cbhi scheme stronger statistically significant positive correlation remaining enrolled training highly correlated followed voting participating general assembly awareness raisinginformation dissemination informal discussionsspontaneously helping possible intermediary outcomes active participation perceived trustworthiness scheme managementpresident accountability informed mechanisms controlling abusefraud also significantly positively correlated remaining scheme perception poor quality health services identified important determinant dropout financial factors seem determine dropout results suggest schemes may able reduce dropout increase quality care creating opportunities active participation caution needed though since cbhi schemes uncritically fund promote participation activities individuals already empowered already higher levels social capital may likely access resources thereby indirectly increasing social inequalities health coverage