Alex Ayebazibwe KakamaAmbrose AtuheireDanson Kahyana2024-09-232024-09-232024https://doi.org/10.1186/s41257-024-00115-5http://hdl.handle.net/20.500.12284/716In southwestern Uganda, a custom of health and social support has been man- aged through collective organizations known as engozi for centuries. Subscribers advanced help for those who were not able to provide for themselves and their house- holds. Participants pooled financial and food resources, offered emotional assis- tance, and aided in transporting patients to hospitals. The institution of “free gov- ernment health amenities” caused the decline of the engozi custom. However, with an insufficient annual health sector budget allocation, the state health services can- not satisfactorily meet the needs. The Kisiizi neighborhood, while depending on the engozi practice, arrived at a CHI system in 1996 as a self-help innovation to elimi- nate financial obstacles and enhance access to quality health amenities. Numerous studies on CHI have examined the structure, registration and memberships, health- related advantages, and monetary-related benefits, but little has been documented on how cultural beliefs and customs have affected its application. This study aimed to identify the role of culture and customs in tackling healthcare disparities via a CHI strategy. This study adopted a case study methodology and qualitative methods. The study utilizes Woolcock’s social capital theory and Cultural competence theory as the analytical framework. It identifies Brotherhood, Solidarity, Belonging, Coop- eration, Volunteering, Reciprocity, and Respect for Authority and Leaders as key values upheld by the engozi tradition, strengthening social capital and laying a solid foundation for successful CHI. This study also identified that societal values and tra- ditions have significantly impacted the implementation of the Kisiizi CHI scheme, as evidenced by the influence on CHI leadership and governance, collecting pre- mium fees from subscribers, mobilization and registration of participants, and infor- mation dissemination. Lastly, the study identified that CHI has positively affected healthcare challenges within the community, evidenced by increased utilization of healthcare services, improved access to antenatal care, health promotion and disease prevention initiatives, and improved quality of services due to user feedback.en-USAttribution-NonCommercial-NoDerivs 3.0 United Stateshttp://creativecommons.org/licenses/by-nc-nd/3.0/us/Community health insurance · Health insurance · Healthcare inequities · Cultural values and traditionsArticle