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What are the lessons learned from Rwanda and Mali expanding community-based health insurance? By Angela Kisakye

What are the lessons learned from Rwanda and Mali expanding community-based health insurance? By Angela Kisakye

Community-based health insurance has been expanding in sub-Saharan African since the late 1990s and still remains one of the most effective and shortest avenues to reach people in rural areas.  This is especially because of the fact that traditional health insurance is difficult to establish in rural areas in Africa because most people work in the informal agricultural sector. They do not have an employer to chip in for their health insurance premiums, a common practice in developed countries.  Community based health insurance schemes require individuals or families to pay a modest annual or monthly subscription to their community health insurance plans which gives the insured persons access to healthcare when they need it. Community based health insurance schemes have faced challenges including; failure to build up adequate reserves to serve the populations sustainably, inconsistences in renewal of subscriptions and insufficient support from the governments to back-up the schemes.

In Africa, Rwanda is one of the countries that has registered success in the community based health insurance scheme with over 65 percent of the population covered by the scheme.  In Mali, the community based health insurance scheme reached a milestone when the government adopted a strategy to co-finance the initiative, paving the way for pilot programs to be launched in two regions of the country. The success of the community based health insurance scheme in Mali is partly attributed to the lessons that the health leaders including technical experts studied during a trip to Rwanda to learn about its community-based plan. The delegation from Mali studied the political and technical aspects of Rwanda’s community health insurance scheme and performance-based financing programs in addition to making the district visits to observe the day-to-day operations of these programs.

From Rwanda, the delegation learnt that the involvement of governments, both local and national was the most important part of the expansion.  For community health insurance to succeed, political willingness of the government to embrace the program and link the insurance to the people is critical. If other African countries could borrow a leaf from countries where community based health insurance has been a success, poor populations would easily access health care when needed.

Further reading

1. Acharya, Arnab; Vellakkal, Sukumar; Taylor, Fiona; Masset, Edoardo; Satija, Ambika; Burke, Margaret; Ebrahim, Shah. 2013. The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review

 

 

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