Browsing by Author "Bart Criel"

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Community Health Insurance (CHI) in Sub-saharan Africa: Researching the Context
(Blackwell Publishing, 2025-06-27) Bart Criel; Chris Atim; Robert Basaza; Pierre Blaise; Maria Pia Waelkens
Community Health Insurance (CHI) is a general term for voluntary health insurance schemes organized at community level, that are alternatively known as mutual health organizations (or mutuelles de sante ´ in French) (Atim 1999), medical aid societies (Atim 1999), medical aid schemes (van den Heever 1997) or micro-insurance schemes (Dror & Jacquier 1999). The common characteristics are that they are run on a non-profit basis and they apply the basic principle of risk-sharing. The last two decades have seen an apparent boom in CHI in sub Saharan Africa, in terms of the sheer number of such initiatives and the increasing attention that some policy makers and development partners are paying to these ventures.1 The rationale for the current wave of promotion of CHI in Africa is based on two main factors. First, the recognition that for African households, financial accessibility to quality health care is a strongly felt need. Second, the success of the Western European experience social health insurance, initiated through small CHI schemes at the end of the 19th and beginning of the 20th century (Ba¨rnig hausen & Sauerborn 2002), suggesting that the financing of health care based on pooling of resources and risk sharing may constitute a relevant policy option for African health care systems.
Community Health Insurance Amidst Abolition of User Fees in Uganda: The View From Policy Makers and Health Service Managers
(BioMed Central, 2010-02-04) Robert K Basaza; Bart Criel; Patrick Van der Stuyft
Background: This paper investigates knowledge of Community Health Insurance (CHI) and the perception of its relevance by key policy makers and health service managers in Uganda. Community Health Insurance schemes currently operate in the private-not-for-profit sector, in settings where church-based facilities function. They operate in a wider policy environment where user fees in the public sector have been abolished. Methods: Semi-structured interviews were conducted during the second half of 2007 with District Health Officers (DHOs) and senior staff of the Ministry of Health (MOH). The qualitative data collected were analyzed using the framework method, facilitated by EZ-Text software. Results: There is poor knowledge and understanding of CHI activities by staff of the MOH headquarters and DHOs. However, a comparison of responses reveals a relatively high level of awareness of CHI principles among DHOs compared to that of MOH staff. All the DHOs in the districts with schemes had a good understanding of CHI principles compared to DHOs in districts without schemes. Out-of-pocket expenditure remains an important feature of health care financing in Uganda despite blanket abolition of user fees in government facilities. Conclusion: CHI is perceived as a relevant policy option and potential source of funds for health care. It is also considered a means of raising the quality of health care in both public and private health units. To assess whether it is also feasible to introduce CHI in the public sector, there is an urgent need to investigate the willingness and readiness of stakeholders, in particular high level political authorities, to follow this new path. The current ambiguity and contradictions in the health financing policy of the Uganda MOH need to be addressed and clarified.
Community Health Insurance in Uganda: Status, Obstacles and Prospects
(Afrika focus, 2011-05-19) Robert Basaza; Patrick Van der Stuyft; Bart Criel
The aim of this thesis is to contribute to the understanding of CHI, both in general and in Uganda specifically. The general objective is to investigate the obstacles and prospects for CHI schemes in Uganda. The specific objectives are: (1) to study demand and supply side factors to explain the low levels of enrolment in existing CHI schemes; (2) to investigate the perceptions of CHI held by those enrolled and those not enrolled in the schemes; (3) to determine knowledge, understanding and perceptions of the relevance of CHI among policy-makers and health service managers; and (4) to formulate evidencebased policy recommendations for the Ugandan health sector_We set the stage for this research by using secondary data sources to embark on a review of the context of CHI schemes in sub-Saharan Africa. Results indicate that the coverage rates of the target population remain low. Other findings suggest that there are five dimensions that seem to be relevant within the framework of the development of CHI: political, economic, social, technical and managerial contexts. We acknowledged the need for more contextualised analyses of both successful and less successful schemes to enhance our collective understanding of why CHI works in certain circumstances and why it fails in others. Therefore, we set out to investigate in detail the emerging features of CHI schemes in East Africa. Schemes from three East African countries (Uganda, Kenya and Tanzania) were examined using a grid to analytically tabulate their features. The key descriptive findings are as follows: (1) the schemes' coverage within their catchment areas was small; (2) the schemes had been in existence for only a short time; (3) they were established with donor support; and (4) they provided both inpatient and outpatient benefits. The findings of this study underscore the role of the government in the promotion of CHI. This is especially true for advocacy, as the government must pay the premiums for the poorest citizens and develop an enabling policy and legal framework. We also concluded that there is a need for primary data to understand the mix of factors involved in CHI schemes.
Community Health Insurance in Uganda: Why Does Enrolment Remain Low? A View From Beneath
(Elsevier, 2008) Robert Basaza; Bart Criel; Patrick Van der Stuyft
Community Health Insurance (CHI) in Uganda faces low enrolment despite interest by the Ugandan health sector to have CHI as an elaborate health sector financing mechanism. User fees have been abolished in all government facilities and CHI in Uganda is limited to the private not for profit sub-sector, mainly church-related rural hospitals. In this study, the reasons for the low enrolment are investigated in two different models of CHI. Focus group discussions and in-depth interviews were carried out with members and non-members of CHI schemes in order to acquire more insight and understanding in people’s perception of CHI, in their reasons for joining and not joining and in the possibilities they see to increase enrolment. This study, which is unprecedented in East Africa, clearly points to a mixed understanding on the basic principles of CHI and on the routine functioning of the schemes. The lack of good information is mentioned by many. Problems in ability to pay the premium, poor quality of health care, the rigid design in terms of enrolment requirements and problems of trust are other important reasons for people not to join. Our findings are grossly in line with the results of similar studies conducted in West Africa even if a number of context-specific issues have been identified. The study provides relevant elements for the design of a national policy on CHI in Uganda and other sub-Saharan countries.
Low Enrolment in Ugandan Community Health Insurance Schemes Underlying Causes and Policy Implications
(BioMed Central, 2025-06-27) Robert Basaza; Bart Criel; Patrick Van der Stuyft
Background: Despite the promotion of Community Health Insurance (CHI) in Uganda in the second half of the 90's, mainly under the impetus of external aid organisations, overall membership has remained low. Today, some 30,000 persons are enrolled in about a dozen different schemes located in Central and Southern Uganda. Moreover, most of these schemes were created some 10 years ago but since then, only one or two new schemes have been launched. The dynamic of CHI has apparently come to a halt. Methods: A case study evaluation was carried out on two selected CHI schemes: the Ishaka and the Save for Health Uganda (SHU) schemes. The objective of this evaluation was to explore the reasons for the limited success of CHI. The evaluation involved review of the schemes' records, key informant interviews and exit polls with both insured and non-insured patients. Results: Our research points to a series of not mutually exclusive explanations for this underachievement at both the demand and the supply side of health care delivery. On the demand side, the following elements have been identified: lack of basic information on the scheme's design and operation, limited understanding of the principles underlying CHI, limited community involvement and lack of trust in the management of the schemes, and, last but not least, problems in people's ability to pay the insurance premiums. On the supply-side, we have identified the following explanations: limited interest and knowledge of health care providers and managers of CHI, and the absence of a coherent policy framework for the development of CHI. Conclusion: The policy implications of this study refer to the need for the government to provide the necessary legislative, technical and regulative support to CHI development. The main policy challenge however is the need to reconcile the government of Uganda's interest in promoting CHI with the current policy of abolition of user fees in public facilities.
What are the emerging features of community health insurance schemes in East Africa?
(Dove Press, 2009-06-16) Robert Basaza; George Pariyo; Bart Criel
Background: The three East African countries of Uganda, Tanzania, and Kenya are characterized by high poverty levels, population growth rates, prevalence of HIV/AIDS, under-funding of the health sector, poor access to quality health care, and small health insurance coverage. Tanzania and Kenya have user-fees whereas Uganda abolished user-fees in public-owned health units. Objective: To provide comparative description of community health insurance (CHI) schemes in three East African countries of Uganda, Tanzania, and Kenya and thereafter provide a basis for future policy research for development of CHI schemes. Methods: An analytical grid of 10 distinctive items pertaining to the nature of CHI schemes was developed so as to have a uniform lens of comparing country situations of CHI. Results and conclusions: The majority of the schemes have been in existence for a relatively short time of less than 10 years and their number remains small. There is need for further research to identify what is the mix and weight of factors that cause people to refrain from joining schemes. Specific issues that could also be addressed in subsequent studies are whether the current schemes provide financial protection, increase access to quality of care and impact on the equity of health services financing and delivery. On the basis of this knowledge, rational policy decisions can be taken. The governments thereafter could consider an option of playing more roles in advocacy, paying for the poorest, and developing an enabling policy and legal framework.