Drivers of community-based health insurance enrolment in post-war Tigray, Ethiopia

BACKGROUND: Community-based health insurance (CBHI) is crucial for strengthening primary healthcare (PHC) and progressing towards universal health coverage (UHC), especially in resource-constrained, war-affected settings. While previous studies have explored CBHI in various contexts, this study uniquely investigates household willingness to join (WTJ) CBHI and its determinants in post-war Tigray, Ethiopia, offering valuable insights into the specific challenges and opportunities in this under-researched setting. METHODS: We conducted a multistage community-based survey across 15 districts within 6 accessible administrative zones, 1 year after the cessation of hostilities, sampling 2289 households in 30 clusters. The primary outcome variable-household WTJ CBHI-was analysed in relation to sociodemographic factors, a wealth index, type of frequently accessed healthcare facility, knowledge on CBHI benefits and prior experience with CBHI. Weighted logistic regression identified significant predictors of WTJ with p