Editorial: A view from beneath: Community Health Insurance in Africa

Abstract

SummaryThis paper presents an overview of the development of Community Health Insurance (CHI) in subSaharan Africa. In 2003, nearly 600 CHI initiatives were registered in a dozen countries of francophone West Africa alone. At regional level, coordination networks have been created in Africa with the aim to support and monitor the developments of this innovative model of health care financing. At national level, governments are preparing the necessary legal frameworks for CHI implementation. CHI is increasingly seen as a strategy to meet other development goals than only health. It constitutes an interesting model to finance health care, to pool financial resources in a fair way and to empower health care users. The CHI movement however still faces many challenges. The relevance of more professional inputs in the management of CHI and the need for careful subsidy of CHI schemes are increasingly recognized. There is also need to optimize the relationship of CHI with the other actors in the health system and to scale-up CHI so as to gain in effectiveness and efficiency. The boom in the number of schemes in Africa during the last years is an indicator of the increasing attractiveness of the model. In practice however, enrolment rates per scheme remain low or are only slowly increasing. Context-specific research is needed on the reasons that prevent people from enrolling in larger numbers. On that basis, relevant action to be taken locally can be identified.

The impact of health insurance in Africa and Asia: a systematic review

“…The strong evidence that CBHI and SHI can improve financial protection and enhance service utilization patterns is especially critical in this respect, but the weaker evidence that CBHI and SHI can foster social inclusion is also important. Although this type of impact is not unexpected in the case of CBHI because of its community orientation, 38 it is more surprising in the case of SHI, which some claim underrepresents the informal sector. 39 Yet targeted policies in the Philippines and Thailand have shown that SHI can reach this sector.…”

“…Whether SHI and CBHI have the same potential impact in settings other than those where the studies were conducted is highly dependent on a particular country's socioeconomic, cultural and political context. 2,12,38,[42][43][44] This is illustrated by the few studies that showed negative impacts of SHI and CBHI on certain domains. Similarly, the review does not provide an answer to the question of whether SHI, CBHI or PHI is the optimal type of health financing mechanism, or of how it compares with tax-based systems -this is also highly dependent on context.…”

Management of hypertension at the community level in Sub-Saharan Africa (SSA): towards a rational use of available resources

“…The limited resources devoted toward health care limit the number of health facilities added to the inexistence of health insurance scheme (23). In such context, the cases of malignant hypertension and target organ damage are frequent (24).…”

Can social capital help explain enrolment (or lack thereof) in community-based health insurance? Results of an exploratory mixed methods study from Senegal

“…The literature proposes the following strategies to address inequity, adverse selection and inadequate supply of health services and insurance: public funding to subsidise premiums, strategies to promote increased revenue collection from the "healthy and wealthy", and improved CBHI management and quality of care (Mills, Ataguba, Akazili, Borghi, Garshong, Makawia et al, 2012;Ndiaye, Soors, & Criel, 2007;Soors et al, 2010). Yet continued low rates of enrolment suggest these strategies have not been successfully implemented.…”