Social protection in an aspiring ‘developmental state’: The political drivers of community-based health insurance in Ethiopia

Ethiopia has been piloting and scaling up a community-based health insurance scheme for the informal sector since 2011, alongside preparations for the launch of a social health insurance scheme for the formal sector. This paper examines the political drivers of the adoption and implementation of the scheme, based on key informant interviews with key figures involved in its elaboration. The paper argues that efforts to extend access to healthcare are linked to the ruling coalition’s longstanding focus on delivering tangible socioeconomic progress as a means of building its legitimacy and securing political support. Health insurance, meanwhile, has secured elite commitment, primarily due to the ‘ideational fit’ between this policy idea and core paradigmatic ideas underpinning the ruling coalition.