Contribution of Mutual Health Organizations to Financing , Delivery , and Access to Health Care Synthesis of Research in Nine West and Central African Countries July 1998

Mutual health organizations (MHOs) are community and employment-based groupings that have grown progressively in West and Central Africa (WCA) in recent years. With this growth has come interest from governments, nongovernmental organizations, and international organizations, particularly those interested in new and innovative approaches to the difficult issues of health care financing and access in the subregion. From mid-1997 to mid-1998 a consultative group led by the United States Agency for International Development-funded Partnerships for Health Reform, the International Labor Office-Appui associatif et coopJratif aux initiatives de dJveloppement B la base/Strategies and Tools against Social Exclusion and Poverty, SolidaritJ Mondiale, and Alliance Nationale des MutualitJs de Belgique, with participation from the Fonds d’aide à la coopJration, the United Nations Children’s Fund, the Institut français de recherche scientifique pour le développment en coopération, and the Deutsche Gesellschaft fur Technische Zusammenarbeit undertook a one-year program of research into the actual and potential contributions of MHOs to the financing of, delivery of, and access to health care in WCA. The study represents an important step forward in documenting and understanding the MHO experience in the WCA subregion. The main purpose is to present information that could be of use to key actors in the development of the MHOs: the members and leaders of those organizations; health care providers; policymakers, especially WCA ministries of health and labor; development partners (external cooperation agencies and technical support institutions); other MHO promoters such as trade unions; and mutualist organizations and associations outside the health sector. This study has confirmed the emergence of a mutual health scheme movement in WCA. These schemes are generally on a small to medium scale in terms of membership. Most are also young: about twothirds of the 50 MHOs (from six countries) in the inventory survey were less than three years old. At present, MHO activities affect only a small fraction of the populations of the countries involved. However, this study shows that they have great potential to embrace more people, as well as to contribute more to the health care sectors of their countries. The study analyzes MHOs’ actual and potential contributions in the areas of (a) access to health care and extending social protection to disadvantaged sections of the population, (b) resource mobilization, (c) efficiency in the health sector, (d) quality improvement, and (e) democratic governance. Given the youth of most of the schemes, assessing their long-term sustainability on the basis of experience to date is not possible. However, the examination of some of their design and institutional features; their administrative and managerial capacities; and their financial performance, including dues collection rates, reveals room for improvement. This study makes a number of recommendations for MHOs that principally concern design features to enhance scheme success. Recommendations for promoters and development partners deal with reinforcing the MHOs’ institutional, managerial, and administrative capacities. Health care service providers with experience in contracting are advised to assist MHOs with pricing and establishing relationships with providers. Finally, recommendations are made on the role of governments in establishing a favorable legal, fiscal, and institutional context. No study can deal exhaustively with all the aspects of a phenomenon as complex and diverse as MHOs, and this study does not claim to have done so. In particular, the study did not investigate the social movement dimension or aspiration of the MHOs, which is potentially one of their major and vital contributions to social and civic life. This paper concludes with an outline of a number of areas that would benefit from further examination.