Community-based health insurance has been expanding in sub-Saharan African since the late 1990s.  But its progress has been uneven. The scale-up stagnated in many countries after governments attempted to eliminate the user fees that were blocking the majority of the population’s access to health services. Then, there simply was not enough money flowing into health systems anymore to cover costs.

Cheikh Mbengue, who works as a long-term advisor with a USAID funded program called Health Systems 20/20 led by Abt Associates, told an audience at the Global Health Council on Monday that community-based health insurance remains the most effective avenue to reach people in rural areas. 

Why is it better than traditional health insurance?

Mbengue said 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. 

But he added that some countries have run out of funding for community-based health insurance schemes.  One way to deal with this challenge, he said, was for governments to support premiums, making them lower for the population. In this arrangement, individuals or families pay a more modest annual or monthly rate to their community health insurance plan, which gives the plan a steady stream of income and insulates people from high payments when they seek care.

Rwanda has figured out a formula to make a community-based health insurance plan work. Today, 65 percent of its population receives health coverage this way.

 “How did Rwanda get where it is today?” Mbengue asked. ”The involvement of governments, both local and national. The most important part [of the expansion] was the political willingness of the government.”

In Mali, a MLI country, political will is driving a community-based health care model known as mutuelles. Last month, Mali 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. Earlier, Mali health leaders visited Rwanda to learn about its community-based plan in a trip sponsored and organized by MLI.

What are the lessons learned from Rwanda, Mali, and other African countries expanding community-based health insurance?

Mbengue said the biggest lesson was that governments needed to embrace the program. “Government has to be involved to really link the insurance to the people,” he said.

 Mbengue’s full presentation is available online.

Photo Credit Dominic Chavez