Community-Based Health Insurance and Capitation Payment Reform Progress Report 2025/26 G.C
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Abstract
The Oromia Region has an estimated population of 44.5 million, with approximately 6.3 million households enrolled in the Community-Based Health Insurance (CBHI) program across 294 rural woredas and 52 towns. Health services are delivered through more than 14,000 public and private health facilities. In alignment with the Health Sector Transformation Plan II (HSTP-II), Oromia has prioritized quality and equity of care, information revolution, competent workforce development, sustainable health financing, and effective leadership and governance.
Description
Health insurance is a prepayment financing mechanism that pools financial resources to protect households from financial hardship and improve access to essential health services. The major types include Community-Based Health Insurance (CBHI), Social Health Insurance (SHI), and Private Health Insurance (PHI). Health insurance is guided by principles of risk sharing, equity, solidarity, and participation, and performs three core financing functions: resource mobilization, risk pooling, and strategic purchasing.
The Oromia CBHI program was initiated as a pilot in 2003 EFY (2011 GC) in four woredas and has expanded to 345 schemes across the region. Evaluations have shown improvements in health service utilization, financial protection, health outcomes, and facility revenue sustainability.