Background
Methods
Data source
Country | Year of survey | Sampled population | |
---|---|---|---|
Weighted number (n) | Weighted % | ||
1. Angola | 2015/16 | 8033 | 3.5 |
2. Benin | 2017/18 | 11,170 | 4.9 |
3. Burkina Faso | 2010 | 13,392 | 5.9 |
4. Burundi | 2016/17 | 9,559 | 4.2 |
5. Cameroon | 2018/19 | 7,463 | 3.3 |
6. Chad | 2014/15 | 4,607 | 2.0 |
7. Comoros | 2012 | 3,291 | 1.5 |
8. Congo | 2011/12 | 6,750 | 3.0 |
9. Congo DR | 2013/14 | 12,409 | 5.5 |
10. Cote d’Ivoire | 2011/12 | 6,411 | 2.8 |
11. Ethiopia | 2016 | 9,824 | 4.3 |
12. Gabon | 2012 | 4,749 | 2.1 |
13. Gambia | 2019/20 | 6,873 | 3.0 |
14. Ghana | 2014 | 5,452 | 2.4 |
15. Guinea | 2018 | 7,812 | 3.4 |
16. Kenya | 2014 | 8,992 | 4.0 |
17. Lesotho | 2014 | 3,609 | 1.6 |
18. Liberia | 2019/20 | 5,875 | 2.6 |
19. Malawi | 2015/16 | 15,952 | 7.0 |
20. Mali | 2018 | 8,332 | 3.7 |
21. Namibia | 2013 | 3,330 | 1.5 |
22. Niger | 2012 | 9,509 | 4.2 |
23. Senegal | 2010/11 | 10,804 | 4.8 |
24. Sierra Leone | 2019 | 9,837 | 4.3 |
25. South Africa | 2016 | 1,359 | 0.6 |
26. Togo | 2013 | 6,353 | 2.8 |
27. Uganda | 2016 | 11,377 | 5.0 |
28. Zambia | 2018 | 7,597 | 3.4 |
29. Zimbabwe | 2015 | 6,013 | 2.7 |
Total
|
226,734
|
100.00
|
Study variables
Outcome variable
Explanatory variable
Covariates
Statistical analyses
Ethical clearance
Results
Background characteristics of respondents
Coverage of health insurance
Distribution of health insurance across explanatory variable and covariates
Variable | Frequency (Weighted %) | Health Insurance coverage (%) | COR (95% CI) |
---|---|---|---|
Overall health insurance coverage
| 226,734 (21.3%, 95% CI; 19.9-22.7%) | ||
Women’s decision-making autonomy
| |||
No | 140,633 (44.1) | 15.7 | Ref |
Yes | 96,376 (55.9) | 25.8 | 1.86 (1.48–2.33)*** |
Women’s age in years
| |||
15–19 | 15,695 (3.40) | 4.90 | Ref |
20–24 | 40,061 (16.8) | 13.7 | 2.62 (1.23–5.61) * |
25–29 | 48,465 (24.9) | 22.5 | 5.75 (2.73–12.12) *** |
30–34 | 41,715 (19.7) | 23.2 | 5.42 (2.60-11.28) *** |
35–39 | 35,622 (15.6) | 25.0 | 6.94 (3.24–14.82) *** |
40–44 | 25,598 (10.5) | 26.0 | 8.44 (3.87–18.37) *** |
45–49 | 19,578 (8.70) | 22.0 | 6.54 (3.04–14.09) *** |
Women’s educational level
| |||
No formal education | 98,811 (9.10) | 2.7 | Ref |
Primary school | 70,054 (54.3) | 12.3 | 4.19 (2.22–7.89) *** |
Secondary school | 50,548 (27.0) | 29.3 | 12.59 (6.61–23.95) *** |
Higher | 7,292 (9.40) | 68.1 | 96.37 (48.09-193.12) *** |
Husband’s educational level
| |||
No formal education | 82,697 (6.60) | 2.4 | Ref |
Primary school | 57,030 (48.0) | 11.0 | 3.53 (1.26–9.83) * |
Secondary school | 64,301 (31.4) | 24.7 | 8.87 (3.13–25.12) *** |
Higher | 15,830 (13.7) | 58.9 | 48.95 (17.11-139.99) *** |
Wealth status
| |||
Poorest | 52,109 (16.7) | 3.0 | Ref |
Poorer | 47,328 (18.0) | 8.2 | 3.01 (1.78–5.08) *** |
Middle | 44,346 (19.0) | 14.9 | 8.22 (4.91–13.76) *** |
Richer | 41,570 (21.6) | 25.8 | 22.60 (13.17–38.77) *** |
Richest | 41,381 (24.5) | 44.3 | 75.66 (42.56-134.53) *** |
Parity
| |||
1–2
| 32,719 (16.5) | 26.2 | Ref |
3–4 | 100,153 (55.6) | 24.3 | 1.03 (0.77–1.38) |
5+ | 78,577 (27.8) | 11.6 | 0.56 (0.39–0.80)** |
Sex of household head
| |||
Male | 188,798 (76.3) | 20.8 | Ref |
Female | 37,936 (23.7) | 22.9 | 1.78 (1.39–2.27)*** |
Currently employed
| |||
No | 81,801 (30.5) | 12.5 | |
Yes | 144,798 (69.4) | 25.2 | 2.65 (2.04–3.45)*** |
Media exposure
| |||
No | 78,479 (13.3) | 3.7 | Ref |
Yes | 147,962 (86.6) | 24.0 | 5.85 (3.53–9.70)*** |
Family size
| |||
< 5 | 68,479 (46.16) | 25.6 | Ref |
>=5 | 158,255 (53.8) | 17.6 | 0.87 (0.71–1.07) |
Place of residence
| |||
Urban | 73,668 (39.5) | 29.8 | Ref |
Rural | 153,066 (60.5) | 15.7 | 0.28 (0.22–0.36)*** |
Distance to health facility
| |||
Big problem | 96,421 (24.4) | 11.4 | Ref |
Not a big problem | 130,272 (75.5) | 24.5 | 1.63 (1.25–2.12)*** |
Community literacy level
| |||
Low | 88,161 (25.8) | 8.9 | Ref |
Medium | 76,206 (35.1) | 20.0 | 3.94 (2.92–5.32)*** |
High | 62,367 (39.0) | 30.6 | 10.86 (8.05–14.65)*** |
Community socioeconomic status
| |||
Low | 122,808 (44.5) | 10.5 | Ref |
Medium | 38,563 (15.5) | 21.5 | 4.77 (3.57–6.38)*** |
High | 65,363 (39.8) | 33.3 | 9.44 (7.33–12.17)*** |
Fixed effect (measure of association)
Variable | Model I | Model II | Model III |
---|---|---|---|
Decision-making autonomy | |||
No | Ref | Ref | |
Yes | 1.33 (1.03–1.72)* | 1.83 (1.46–2.29)*** | 1.33 (1.03–1.72)* |
Women’s age
| |||
15–19 | Ref | Ref | |
20–24 | 1.17 (0.41–3.34) | 1.15 (0.40–3.28) | |
25–29 | 2.04 (0.70–5.92) | 2.01 (0.69–5.80) | |
30–34 | 2.10 (0.73–6.04) | 2.06 (0.72–5.91) | |
35–39 | 3.10 (1.03–9.28)* | 3.02 (1.01–9.05)* | |
40–44 | 3.88 (1.25-12.00)* | 3.78 (1.22–11.71)* | |
45–49 | 2.51 (0.81–7.74) | 2.44 (0.79–7.51) | |
Women’s educational level
| |||
No formal education | Ref | Ref | |
Primary school | 1.84 (0.86–3.94) | 1.73 (0.80–3.74) | |
Secondary school | 3.51 (1.59–7.73)** | 3.29 (1.48–7.35)** | |
Higher | 11.42 (4.76–27.36)*** | 10.62 (4.37–25.81)*** | |
Husband educational level
| |||
No formal education | Ref | Ref | |
Primary school | 1.12 (0.37–3.40) | 1.12 (0.36–3.43) | |
Secondary school | 1.73 (0.55–5.41) | 1.72 (0.54–5.45) | |
Higher | 4.33 (1.41–13.24)* | 4.32 (1.40-13.33)* | |
Wealth status
| |||
Poorest | Ref | Ref | |
Poorer | 1.75 (0.98–3.12) | 1.66 (0.94–2.94) | |
Middle | 3.83 (2.15–6.81)*** | 3.57 (2.01–6.33)*** | |
Richer | 6.75 (3.71–12.26)*** | 6.19 (3.37–11.36)*** | |
Richest | 12.70 (6.51–24.80)*** | 11.64 (5.68–23.82)*** | |
Parity
| |||
One | Ref | Ref | |
2–4 | 1.25 (0.81–1.95) | 1.26 (0.81–1.97) | |
5+ | 0.69 (0.39–1.20) | 0.70 (0.40–1.22) | |
Currently employed
| |||
No | Ref | Ref | |
Yes | 2.20 (1.61–3.01)*** | 2.19 (1.60-3.00)*** | |
Media exposure
| |||
No | Ref | Ref | |
Yes | 1.78 (1.05–3.01)* | 1.77 (1.05-3.00)* | |
Sex of household head
| |||
Male | Ref | Ref | |
Female | 1.47 (1.12–1.93)** | 1.48 (1.13–1.94)** | |
Distance to health facility
| |||
Big problem | Ref | Ref | |
Not a big problem | 1.52 (1.16–1.99)** | 1.20 (0.89–1.62) | |
Place of residence
| |||
Urban | Ref | Ref | |
Rural | 0.99 (0.76–1.28) | 1.25 (0.93–1.68) | |
Community literacy level
| |||
Low | Ref | Ref | |
Medium | 2.43 (1.80–3.29)*** | 1.06 (0.73–1.55) | |
High | 4.20 (3.07–5.73)*** | 1.47 (1.00-2.15)* | |
Community socioeconomic status
| |||
Low | Ref | Ref | |
Medium | 3.07 (2.28–4.14)*** | 1.79 (1.27–2.54)** | |
High | 4.54 (3.33–6.19)*** | 1.13 (0.75–1.70) |
Random effect (measure of variation)
Random effect | Model 0 | Model I | Model II | Model III |
---|---|---|---|---|
PSU variance (95% CI) | 4.81 (4.14–5.58) | 3.67 (3.08–4.38) | 3.28 (2.79–3.85) | 3.65 (3.07–4.34) |
ICC | 0.59 | 0.52 | 0.50 | 0.52 |
Wald chi-square and p-value | Ref | χ2 = 398.44, p < 0.001 | χ2 = 390.58, p < 0.001 | χ2 = 518.64, p < 0.001 |
Model fitness
| ||||
Log-likelihood | -12242.85 | -9159.73 | -11897.726 | -9140.49 |
AIC | 24489.71 | 18367.47 | 23813.45 | 18340.98 |
N |