Community Health Insurance (CHI) in Sub-saharan Africa: Researching the Context

Abstract

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.