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Community-based health insurance (CBHI) as a demand-side intervention is presumed to drive improvements in health services quality, and the quality of health services is an important supple-side factor in motivating CBHI enrollment and retention. There is, however, limited evidence on this interaction. This study examined the interaction between quality of health services and CBHI enrollment and renewal. A mixed-method comparative study was conducted in four agrarian regions of Ethiopia. The study followed the Donabedian model to compare quality of health services in health centers located in woredas/districts that implemented CBHI with those that did not. Data was collected through facility assessments, client-exit interviews, and key informant interviews. In addition to manual thematic analysis of qualitative data, quantitative descriptive and inferential analyses were done using SPSS vs 25. The process related (composite index including provider-client interpersonal communication) and outcome related (client satisfaction) measures of service quality in CBHI woreda/districts differed significantly from non-CBHI woredas/districts, but there were no significant differences in overall measures of structural quality between the two. The study found better diagnostic test capacity, availability of tracer drugs, provider interpersonal communication, and service quality standards in CBHI woredas. A higher proportion of clients at CBHI health centers gave high ratings of overall satisfaction with services. Individual and household factors including family size, age, household health care-related expenditures, and educational status, played a more significant role in CBHI enrollment and renewal decisions than health service quality. Key-informants reported in interviews that participation in the scheme increased accountability of health facilities in CBHI woredas/districts, because they promised to provide quality services using the CBHI premium collected at the beginning of the year from all enrolled households. This study indicates a need for follow-up research to understand the nuanced linkages between quality of care and CBHI enrollment.

Background: Lack of timely household (HH) level data to inform evidence-based decision-making for improved, timely and targeted health interventions is challenging. Integrated Family Health Program (IFHP) developed and implemented a system for collecting data on an on-going basis at household levels. Objective: To discuss the implementation of the continuous household surveys of the IFHP. Methods: Continuous surveys were used for generating timely data for monitoring outcome indicators. Integrated Family Health Program conducted continuous cross-sectional household surveys in its four major target regions over the past 6 years. This approach facilitated the aggregation of data annually, thus enabling progress to be tracked over time and timely decision-making. A total of 2560 households were interviewed each year and trend report synthesised for use. Result: Key performance indicators in the areas of family planning, and maternal and child health were considered for the study. Time series analysis data revealed overall progress in each outcome indicator. The report was shared among key programme staff to provide data for informed programmatic decision-making. Conclusion: The surveys as part of other programme activities proved to be a feasible and efficient way to generate timely data for programme outcome monitoring. Documenting the design and implementing data collection and feedback mechanism for prospective description and outcome monitoring potentially represents a new paradigm for course correction. Recommendation: Programme implementers should plan integrated continuous programme outcome monitoring mechanism as part of programme design rather than waiting for mid-term or end-term project evaluation.