The emergence of the national medical assistance scheme for the poorest in Mali

Abstract

Background: Universal health coverage (UHC) is now high up the international agenda. There are still major needs to be met in West Africa, particularly in Mali, where providing health care for the poorest remains a big challenge. The majority of the region’s countries are currently seeking to define the content of their compulsory, contribution-based medical insurance system. However, very few countries apart from Mali have decided to, in parallel, develop a solution for poorest that is not based on contributions.Methods: This qualitative research article examines the historical process that has permitted the emergence of this ground-breaking public policy.Results: The research shows that the process has been very long, chaotic and sometimes suspended for long periods. One of the biggest challenges has been that of intersectoriality and the social construction of the groups to be targeted by this public policy (the poorest), as institutional tensions have evolved in accordance with the political issues linked to social protection. Eventually, the medical assistance scheme for the poorest (RAMED) saw the light of day in 2011, funded entirely by the government.Conclusions: Its emergence would appear to be attributable not so much to any new concern for the poorest in society but rather to a desire to give the social protection policy engaged in a guarantee of universality. The RAMED nonetheless remains an innovation within French-speaking West Africa.

Defining an action-research’s content to improve a policy supporting indigents’ health in Mali: a concept mapping

“…Following the examples of Algeria, 4 Tunisia, 5 or Morocco, 6 Mali is one of the rare West African countries to have a public policy designed to provide free access to health services for indigents. 7 For operational purposes, Malian officials decided that indigents would represent the poorest 5% of the general population in Mali. The package of care offered to that population is equivalent to the one offered to the beneficiaries of compulsory health insurance (AMO), except for the specialty drug coverage.…”

“…8 In 2009, the State introduced a non-contributory scheme, the RAMED which is dedicated to care for the in-digent; that is, to "any person without resources and recognized as such by the territorial community to which he belongs". 9 It is publicly funded from the State and local authorities 7 and is managed by the Agence Nationale Assistance Médicale (ANAM), a national public administrative institution with legal personality and financial autonomy. 10 It is responsible for registering beneficiaries and is under the Ministry of Solidarity and Humanitarian Action (MSAH).…”

“…In the context of a partnership between an interdisciplinary research team and ANAM actors, we collectively decided to engage in action research to find operational solutions to improve indigents' care and make RAMED more functional. 7 An action-research was justifiable by the need for ANAM agents to find concrete and collective solutions (e.g., problems in defining and operationalizing a policy of free care for the indigent). [11][12][13] This responds to the lack of evidence about interventions in favour of the poorest in Africa.…”