Exploratory study of the impacts of Mutual Health Organizations on social dynamics in Benin

Ridde, Valéry; Haddad, Slim; Yacoubou, Moussa; Yacoubou, Ismaelou

doi:10.1016/j.socscimed.2010.03.047

Cited by 26 publications

(29 citation statements)

References 28 publications

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“…The few studies on community participation in CBHI present contradictory results. Two qualitative studies (De Allegri et al, 2006;Ridde et al, 2010) compare the views of members of CBHI to non-members and find that although levels of active community participation in CBHI were generally low, people did not point to this as a reason for not enrolling. In contrast, two other qualitative studies (Atim, 1999;Basaza et al, 2007) compare schemes in which the level of active community participation was high with schemes with low active participation and suggest that higher active participation may be one of the factors accounting for higher levels of enrolment.…”

Section: Community Participation In Cbhimentioning

confidence: 99%

“…To provide a conceptual framework to guide the analysis, examples of active community participation in CBHI identified in the literature on sub-Saharan Africa (Atim, 1999;Basaza et al, 2007;Criel et al, 2005;Criel & Waelkens, 2003;De Allegri et al, 2006;Ridde et al, 2010;Schneider, 2005;Waelkens & Criel, 2007) are categorised according to Rifkin's (1986) framework (Table 1).…”

Section: Objectives Of the Studymentioning

confidence: 99%

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Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Mladovsky¹

2014

Social Science & Medicine

116

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AcknowledgementsThe author would like to thank Bart Criel, Pascal Ndiaye, Alfed Ndiaye, Werner Soors and all national stakeholders in Senegal for their contributions to the research project, the team of fieldwork assistants and supervisors, staff of the three CBHI schemes who gave up their time to facilitate the research, all the interviewees who also gave their time, the Institute of Tropical Medicine, Antwerp and the Stewart Halley Trust for providing funding for the research, and the two anonymous reviewers who provided valuable comments and insights. AbstractAlthough a high level of drop-out from community-based health insurance (CBHI) is frequently reported, it has rarely been analysed in depth. This study explores whether never having actively participated in CBHI is a determinant of drop-out. A conceptual framework of passive and active community participation in CBHI is developed to inform quantitative data analysis. Fieldwork comprising a household survey was conducted in Senegal in 2009. Levels of active participation among 382 members and ex-members of CBHI across three case study schemes are compared using logistic regression. Results suggest that, controlling for a range of socioeconomic variables, the more active the mode of participation in the CBHI scheme, the stronger the statistically significant positive correlation with remaining enrolled. Training is the most highly correlated, followed by voting, participating in a general assembly, awareness raising / information dissemination and informal discussions / spontaneously helping. Possible intermediary outcomes of active participation such as perceived trustworthiness of the scheme management / president; accountability and being informed of mechanisms of controlling abuse/fraud are also significantly positively correlated with remaining in the scheme. Perception of poor quality of health services is identified as the most important determinant of drop-out. Financial factors do not seem to determine drop-out. The results suggest that schemes may be able to reduce drop-out and increase quality of care by creating more opportunities for more active participation. Caution is needed though, since if CBHI schemes uncritically fund and promote participation activities, individuals who are already more empowered or who already have higher levels of social capital may be more likely to access these resources, thereby indirectly further increasing social inequalities in health coverage.

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Section: Community Participation In Cbhimentioning

confidence: 99%

Section: Objectives Of the Studymentioning

confidence: 99%

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Mladovsky¹

2014

Social Science & Medicine

116

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“…Removing user-fees for under-18s would be an important step to facilitating effective health-seeking and ability to access higherquality services, in Ghana and elsewhere. However, as we have indicated, user-fees are not the only barrier to health-service use for young people, particularly those living in rural areas (Airey, 1992;Ridde et al, 2010;Franco et al, 2008). Even with health insurance, for those without effective access to appropriate, affordable services (both formal and informal), good quality healthcare is still as out of reach as ever.…”

Section: Implications For Policy and Practicementioning

confidence: 97%

“…Across Africa, there has been a surge of interest in mutual health insurance schemes to address the obstacle of user fees to service utilisation (Ridde et al, 2010;Ridde and Haddad, 2009;Ansah et al, 2009;Franco et al, 2008). Ghana's National Health Insurance Scheme (NHIS), introduced in 2001, had achieved 38% coverage of the population by December 2006 (Agyepong and Adjei, 2008), the start of our field research.…”

Section: Shifting Therapeutic Landscapesmentioning

confidence: 99%

“…(Mary, 11y, urban)* However, the benefits of the NHIS have not reached all children. Under-18s are only eligible for insurance if their parents are registered and their annual premiums are up to date; this is unaffordable for many (see Ridde et al, 2010;Franco et al, 2008). Abigail went on to say that her NHIS card had since expired, and her father could not afford to renew it.…”

Section: National Health Insurance Scheme (Nhis)mentioning

confidence: 99%

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Out of the reach of children? Young people’s health-seeking practices and agency in Africa’s newly-emerging therapeutic landscapes

Hampshire¹,

Porter²,

Owusu³

et al. 2011

Social Science & Medicine

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Publisher's copyright statement: NOTICE: this is the author's version of a work that was accepted for publication in Social science medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be re ected in this document. Changes may have been made to this work since it was submitted for publication. A de nitive version was subsequently published in Social science medicine, 73/5, 2011, 10.1016/j.socscimed.2011.06.035 Additional information: Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. OUT OF THE REACH OF CHILDREN? YOUNG PEOPLE'S HEALTH-SEEKING AGENCY IN AFRICA'S NEWLY-EMERGING THERAPEUTIC LANDSCAPES AbstractDespite a dominant view within Western biomedicine that children and medicines should be kept apart, a growing literature suggests that children and adolescents (in both Western and developing-country contexts) often take active roles in healthseeking. Here, we consider young people's health-seeking practices in Ghana: a country with a rapidly changing therapeutic landscape, characterised by the recent introduction of health insurance, mass advertising of medicines, and increased use of mobile phones. Qualitative and quantitative data are presented from eight field-sites in urban and rural Ghana, including 131 individual interviews, focus groups, plus a questionnaire survey of 1005 9-to-17-year-olds. We show that many young people take active responsibility for their own (and others') healthcare. However, there is substantial variation in healthseeking practices and associated agency; these processes are shaped by (and also shape) resources available, including economic, social, cultural, psychological, informational and locational forms of capital. Dynamic interactions between resources and healthseeking agency operate within a wider, rapidly-changing therapeutic landscape, which has opened access to a greater range of healthcare possibilities. We conclude by considering implications for health and wellbeing, and suggest possible interventions for facilitating young people to seek healthcare safely and effectively.

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Acceptability of innovative department community‐based health insurance in central Mali: A mixed methods study

Boivin,

Ravalihasy,

Diarra

et al. 2024

Health Planning & Management

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As the Universal Health Insurance Plan (RAMU) is gradually being implemented in Mali, community‐based health insurance (CBHI) —considered one of the pillars of this programme— must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale than before, moving from municipalities to circles (departments). A mixed‐method study was carried out in the Mopti region to assess the acceptability of this innovation among CBHI elected representatives. In April 2021, 118 questionnaires were administered to CBHI elected representatives, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon et al. (2017) developed an approach outlining seven dimensions of acceptability (attitude, burden, values, coherence, opportunity costs, perceived efficiency, and personal effectiveness), which was used as a conceptual model for data analysis. The results obtained by factor analysis indicate that more than half of individuals (58%) reported above‐average acceptability. Elected representatives feel well supported in their activities by the Technical Union of Malian Mutuality (TUM), the umbrella organisation of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected representatives note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. The new CBHI is highly advantageous for the population in terms of content, financial, and geographical access. Professionalisation is an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected representatives are concerned about the sustainability of this CBHI and rely on the State and its partners to assume responsibility. The TUM will play an essential role in continuing its support and fulfiling its functions as a delegated management organisation within the framework of the RAMU.

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Exploratory study of the impacts of Mutual Health Organizations on social dynamics in Benin

Cited by 26 publications

References 28 publications

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Out of the reach of children? Young people’s health-seeking practices and agency in Africa’s newly-emerging therapeutic landscapes

Acceptability of innovative department community‐based health insurance in central Mali: A mixed methods study

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