Mutual health organizations (MHOs) are voluntary membership organizations providing health insurance services to their members. MHOs aim to increase access to health care by reducing out-of-pocket payments faced by households. We used multiple regression analysis of household survey data from Ghana, Mali and Senegal to investigate the determinants of enrolment in MHOs, and the impact of MHO membership on use of health care services and on out-of-pocket health care expenditures for outpatient care and hospitalization. We found strong evidence that households headed by women are more likely to enrol in MHOs than households headed by men. Education of the household head is positively associated with MHO enrolment. The evidence on the association between household economic status and MHO enrolment indicates that individuals from the richest quintiles are more likely to be enrolled than anyone else. We did not find evidence that individuals from the poorest quintiles tend to be excluded from MHOs. MHO members are more likely to seek formal health care in Ghana and Mali, although this result was not confirmed in Senegal. While our evidence on whether MHO membership is associated with higher probability of hospitalization is inconclusive, we find that MHO membership offers protection against the potentially catastrophic expenditures related to hospitalization. However, MHO membership does not appear to have a significant effect on out-of-pocket expenditures for curative outpatient care.

Background: Kenya, like many other countries in sub-Saharan Africa, has been affected by shortages of health workers in the public sector. Data on the rates and leading reasons for health workers attrition in the public sector are key in developing effective, evidence-based planning and policy on human resources for health.

No study has evaluated the impact of giving CHWs free urine pregnancy test kits for distribution to improve provision of hormonal contraceptives. Giving CHWs free pregnancy test kits significantly increases the number of clients to whom they sell hormonal contraceptives. Community-based distribution programs should consider including these tests among CHWs' services.

Treatment of drinking water at the household level is one of the most effective preventive interventions against diarrhea, a leading cause of illness and death among children in developing countries. A pilot project in two districts in Rwanda aimed to increase use of Sûr'Eau, a chlorine solution for drinking water treatment, through a partnership between community-based health insurance schemes and community health workers who promoted and distributed the product.Evaluation of the pilot, drawing on a difference-in-differences design and data from pre-and postpilot household surveys of 4,780 households, showed that after 18 months of pilot implementation, knowledge and use of the product increased significantly in two pilot districts, but remained unchanged in a control district. The pilot was associated with a 40-42 percentage point increase in ever use, and 8-9 percentage points increase in use of Sûr'Eau at time of the survey (self-reported measures). Our data suggest that exposure to inter-personal communication on Sûr'Eau and hearing about the product at community meetings and health centers were associated with an increase in use.

PATH collaborated with manufacturers and microfinance institutions (MFIs) in India and Cambodia to test the impact of consumer finance models on uptake and use of household water filters. Six pilots were implemented using different filters, partners, and loan plans. The pilots predominantly reached households from the middle three country-specific wealth quintiles. Purchase rates ranged from 5 to 44% among MFI members and increased with household wealth quintile. Cost recovery for the pilots ranged from 33 to 109%. The results suggest that MFI loans can have the potential, in certain contexts, to provide an effective and commercially sustainable means of increasing uptake of water treatment solutions for MFI member households.