Indigenous social insurance as an alternative financing mechanism for health care in Ethiopia (the case of eders)

With increasing demand for services further propagated by population growth and by people's response to newly emerging pathologies, nations in sub-Saharan Africa are faced with insurmountable problems in sustaining their health systems. Realizing the inadequacy of solely relying on the public sector, these countries are seeking alternative mechanisms for health financing. Among the alternatives suggested are risk-sharing mechanisms that include community-based schemes that tap the potential of indigenous social arrangements. In Ethiopia, eders are major forms of indigenous arrangements utilized mainly for assisting victims in bereavement and executing funeral-related activities. These associations are also called upon in various self-help activities and sometimes provide health insurance, even though mostly in an informal manner. Therefore, they have the potential to serve as social financing mechanisms. Since these are already functioning groups, the administrative cost for the extra health-related activity will not be as high as in the case of forming a new insurance entity. In addition, the fact that eders are based on mutual understanding among members minimizes the possibility of adverse selection. Based on the above background, an exploratory study was conducted in 40 villages distributed in various parts of Ethiopia to assess the possible roles eders might play in providing insurance for health financing. Both qualitative and quantitative (household and health facility exit interview surveys) methods of data collection were utilized. The study concludes that eder-based schemes are, indeed, options for experimentation as mechanisms for financing health care in rural Ethiopia. It was also found that 21.5% of respondents in the household and 16% of those in the exit surveys were already utilizing eders to finance part of their health expenditure. In addition, 86% of the respondents in the household and 90% of those in the exit survey were willing to participate in eder-based health insurance schemes.