Mutual Health Insurance, scaling-Up and the Expansion of Health Insurance in Africa

The objective of this paper is to contribute to a common understanding of the concept of expansion of health insurance based on the specific features of community mutual health organizations (MHOs) in Africa. The proposed policy analysis framework presents the expansion of health insurance based on the MHO concept as a process that uses MHO principles to develop health insurance schemes that serve as the foundation for health insurance. The health insurance expansion process is presented as the product Mutual Health Insurance, scaling-Up and the Expansion of Health Insurance in Africa of the synergy between bottom-up community processes and top-down modes and mechanisms of government intervention to create an environment that encourages scaling up and expanding social health protection coverage in the rural and informal sectors. The analytical framework is the starting point for a comparative analysis of the various experiences with expanding MHOs and health insurance in a sampling of African countries: Benin, Cameroon, Ghana, Niger, Rwanda and Senegal. The analysis identifies major gaps in the policy environment in some of the French-speaking African countries where legal frameworks are still being prepared, financing support mechanisms are absent, technical assistance services are provided primarily by diverse nongovernmental organizations and foreign partners using different approaches, and supervisory and regulatory agencies have yet to be set up. By contrast, efforts to expand health insurance using the MHO concept are more coordinated in Ghana and Rwanda, where strategic support frameworks that combine complementary legislative, financial and technical interventions have enabled a rapid expansion of insurance coverage in the rural and informal sectors. It was possible to learn lessons from this experience by identifying principles to inform the debate and strategic directions for expanding health insurance based on the MHO concept in Sub-Saharan Africa: z The expansion of health insurance based on community MHOs should be supported by 2 HealthSystems20/20 strong political will and leadership at several levels in order to mobilize and coordinate the efforts of multiple actors at the national and local levels in a sustainable fashion. z The principle of equity in financing should be used to determine financing mechanisms as part of the measures to expand health insurance based on community MHOs so that the citizens who have means subsidize citizens who cannot afford to pay. z The combination of financing sources and mechanisms as integral measures to expand health insurance through MHOs is based on the synergy between public funding (itself based on the principle of national solidarity), and the MHO concept (based on the principles of solidarity, mutual assistance and prepayment at the local level). z Aligning community health insurance organizations with decentralized governmental units permits structural equivalence, and leveraging of the political and technical capacities of the decentralized entities to rapidly scale up community-based health insurance to the entire country.