François Diop Abdoulaye Ba Christine OrtizAbt Associates Inc.

A Framework for Success: Comparative Analysis of African Community-based Health Insurance Initiatives

APHA 2010, Denver

Why improve health insurance coverage through community-based initiatives?

Social Inclusion Increased access to care Income protection

Members of the MUSADA scheme in Burkina Faso

Health financing in sub-saharan Africa

Where does the money come from? Public sector – national programs Individuals – out of pocket

What types of mechanisms are used? Social health insurance Subsidized or free care public systems Community-based schemes (MHOs,

CBHI, mutuelles)

Senegalese women

Senegal

Ghana Benin

Niger

Cameroon

Rwanda

Africa

Comparative table

Country Total pop % RuralGDP/ capita

Per capita total

expend. on health

Gov’t % of total expend.

OOP as % of total health

expend.

Total expend. on H as % GDP

%

population with

health insurance

Benin9,025,40

259.2 $328.08 $29.00 13.1 46.7 5.3 18%

Cameroon

18,532,799

44.1 $696.75 $51.00 28.1 68.2 5.2 19% 

Ghana23,461,5

2350.7 $306.80 $35.00 6.8 50.0 6.2 40%

Kenya 37,530,7

2678.7 $459.58 $29.00 6.1 41.4 4.6 20%

Mali12,334,1

6868.4 $289.10 $30.00 12.2 48.1 6.0 8%

Niger14,195,0

8583.5 $168.70 $10.00 10.6 40.3 4.0 <5% 

Rwanda9,735,54

181.9 $271.31 $32.00 27.3 22.7 10.4 74%

Senegal12,411,0

9457.9 $509.03 $40.00 6.7 61.9 5.4 20%

Tanzania40,432,1

6374.9 $354.17 $18.00 13.3 34.0 5.5 16%

Zambia11,919,8

7064.7 $386.05 $49.00 10.8 37.8 5.2 22%

Why focus on mutual health organizations?

Comparative advantage of community-based initiatives: a way to reach rural and informal sectors in Africa

Can provide a link between local level and central government + public resources

Mutuelle members in Rwanda

Rwanda Ghana

Success stories

Women at a primary health clinic in Rwanda proudly hold up their mutuelle membership cards

Functional methodology

Dear Ma Claudia, please paste in the graphic from the article you did (English version). The word copy I have is ugly. http://www.hs2020.org/content/resource/detail/2523/

p5 Thanks

How to increase health insurance coverage in Africa

Bottom-up + Top down

A patient proudly displays his insurance membership card after visiting the Mulindi health center in Byumba, Rwanda

Reports related to this presentation are available at www.healthsystems2020.org

Thank you