How Ethiopia used CLA in Implementing Community-Based Health Insurance

Health is under-financed in Ethiopia limiting health care access by poor and marginalized populations. Without financial risk protection mechanisms, these populations pay out of pocket when seeking care, which is prohibitive for most, and catastrophic for many. To improve access, USAID’s Health Financing Improvement Program (the Program) strengthens the Government of Ethiopia’s (GOE) health care financing initiatives for reducing financial barriers. Community-Based Health Insurance (CBHI) is an initiative aimed at increasing access to health care, protecting households from financial hardship, and improving the health status of Ethiopians. GOE had ambitious targets: rapid expansion of CBHI to all regions and city administrations, and to cover 80% of woredas and 80% of the target population. But there was a simultaneous need to address challenges identified in the pilot, maintain buy-in from autonomous levels of government and different ministries, and adapt the rural pilot program to Ethiopia’s urban and pastoral populations.

Program management made Collaborating, Learning, and Adapting (CLA) practices an integral part of its support for CBHI since the beginning. It facilitated collaboration among government stakeholders — the Ministry of Health, Ethiopian Health Insurance Service, and Ministry of Finance and the autonomously operated Regional, Zonal, and Woreda (district) Health Bureaus. All of these stakeholders and USAID collaboratively developed a learning agenda to support GOE and the Programs shared objectives. The learning agenda included questions that specifically addressed CBHI expansion.

Through integrated performance review mechanisms including results tracking, joint supportive supervision, and research activities – autonomous stakeholders institutionalized a CLA culture across CBHI implementation.