{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T23:21:35Z","timestamp":1792106495209,"version":"4.4.0"},"reference-count":78,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T00:00:00Z","timestamp":1738540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sidama National Regional Health Bureau","award":["no"],"award-info":[{"award-number":["no"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Accessing affordable and high-quality healthcare remains a persistent challenge in low- and middle-income countries like Ethiopia. Community-based health insurance (CBHI) programs offer a promising solution to expand healthcare coverage and provide financial protection, particularly for vulnerable populations such as women. This study aimed to investigate the factors that influence CBHI enrollment among women in Sidama National Regional State, Ethiopia, using a multilevel analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A community-based cross-sectional study was conducted using a multistage sampling technique from December 15<jats:sup>th<\/jats:sup> to January 12<jats:sup>th<\/jats:sup>, 2024, in the central Sidama zone, Sidama National Regional State. The study included 835 women aged 18 years and older, residing both in rural and urban areas. Face-to-face interviews were conducted using a pre-tested questionnaire to collect comprehensive data on socio-demographic, economic, and scheme-related factors. Data collection utilized the Open Data Kit mobile application, and data analysis was performed using Stata version 16, employing multilevel modified Poisson modeling to identify determinants of CBHI enrollment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 845 samples, 835 women were interviewed, resulting in a response rate of 98.8%. Individual-level factors such as older age (APR = 1.02, 95%CI: 1.01\u20131.03, p&lt;0.001), larger family size (APR = 1.09, 95%CI: 1.03\u20131.16, p = 0.001), and moderate wealth index (APR = 2.72, 95%CI: 1.28\u20135.79, p = 0.009) showed positive associations with CBHI enrollment, depicted a higher likelihood of individuals joining the insurance scheme. In addition, at the community level, higher rates of women\u2019s literacy (APR = 1.73, 1.18\u20132.55, p = 0.005), and women\u2019s autonomy (APR = 2.64, 95%CI: 1.50\u20134.65, p = 0.001) were positively correlated with CBHI enrollment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The study revealed that the enrollment rate among women in the CBHI scheme was 35%, indicating a need for improved outreach efforts. Significant factors that affected enrollment included older age, larger family size, and moderate wealth. Additionally, positive community-level influences such as higher literacy rates and increased autonomy for women contributed to higher enrollment. To improve CBHI enrollment, the target should focus on younger women and those from smaller families. Financial support, such as subsidies for low-income women, can also encourage participation. Investing in women\u2019s literacy and empowerment programs will enable them to make informed health choices, thereby increasing enrollment. Finally, ongoing research is necessary to track enrollment trends and identify barriers. Utilizing qualitative methods will yield insights into women\u2019s perceptions of CBHI, facilitating more effective strategies. Implementing these recommendations can enhance women\u2019s access to healthcare through CBHI.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0316948","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T18:26:00Z","timestamp":1738607160000},"page":"e0316948","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Women\u2019s enrollment in community-based health insurance and its determinants in Sidama national regional state, Ethiopia, 2024: A multilevel analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6118-9153","authenticated-orcid":true,"given":"Kare Chawicha","family":"Debessa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keneni Gutema","family":"Negeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesay Hailu","family":"Dangisso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"pone.0316948.ref001","unstructured":"WHO (2018) A vision for primary health care in the 21st century: towards universal health coverage and the Sustainable Development Goals. 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