Abstract

Access to affordable and effective health care is a major problem in low and middle income countries (LMIC) and out-of-pocket expenditure for health care a major cause of impoverishment. One way to facilitate access and overcome catastrophic expenditure is through a health insurance mechanism, whereby risks are shared and financial inputs pooled by way of contributions from salaries or taxation. In LMIC today, the majority of people are either self-employed or work in the informal sector, which makes expansion of formal health insurance, if any, much more difficult. Taxation systems are generally insufficiently developed and do not allow for adequate revenue collection to ensure universal coverage. One response to the difficulty of providing insurance coverage for people in the informal sector is the development of community-based health insurance.