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Project background in Sub-Saharan Africa…

 

  • Private insurance products hardly exist in rural areas and urban slums in Sub-Saharan Africa (SSA), and in cases where they do, they are usually neither affordable for poor parts of the population nor do they correspond to the people's needs
  • Public Social Insurance Services are mostly insufficient and exclude people working in the informal sector
  • Nine out of ten people in SAA do not have any access to health or accident insurance
  • They have to pay tremendously high fees for treatment, medical care and hospitalisation out of pocket
  • Especially those people living below the poverty line (more than 40% in SSA) have to take out loans, dissolve their savings or sell essential resources to pay for their treatment
  • Numerous people don’t have access to the required services at all just as many people fall into poverty due to illness and treatment costs

Micro Health Insurance in Africa...

  • Micro Health Insurance (MHI) has already a long tradition in many societies in Africa, particularly in many societies in West Africa like in the Thiés region of Senegal, but also in East and Central Africa like in Rwanda where MHIs are existing already since over 60 years
  • In many other African countries like in DR Congo, Mali, Burkina Faso, Benin, Ghana and Kenya, micro health insurance units were built up in the 1980ies and 1990ies, in Kenya and Ghana the MHIs can be traced back to mission hospitals that offered free or low cost health services
  • The establishment of community based health insurance in Africa can be seen as a reaction to the introduction of user fees and cost-recovery programs within the health sector reforms of many African governments after post-independence welfare practices that indeed offered health services for free but still excluded particularly very poor people in rural areas from any health service
  • In the context of these cost-recovery programs, out-of-pocket payments and user fees were introduced at existing, publicly provided health facilities

Factors that encouraced the spread of MHIs in Africa:

  • The introduction of user fees in a context of generally unacceptable quality of public services, that encouraged people’s willingness to pay for better quality care (for instance at missionary hospitals)
  • The rise of alternative, private sources of health care provision, frequently associated with good quality                 
  • The general democratization and development of civil society in the last decade

 

This table shows the existing MHIs in 19 african countries, the data was taken from different case studies that were conducted in the 1990ies and also after 2000:

* * * MHIs in Africa * * * MHIs in Africa * * * MHIs in Africa * * * MHIs in Africa * * * MHIs in Africa * * * MHIs in Africa * * *
Country People covered Functional schemes Remarks on Sources
Benin 41428 120 1998 (1), 2000 (5), Est. 2006 (8)
Burkina Faso 17873 60 2000 (5), Est. 2006 (8), 2007 (11)
Burundi n/a 1 2001 (2)
Cameroon 15947 30 2000 (5), Est. 2006 (8)
Chad 1775 11 2003 (9)
DR Congo 103926 103 1998 (1)/(3), 1999 (6), 2001 (2), 2007 (12)
Ghana n/a 168 1998 (1)/(3), 2000 (5), 2001 (2), 2005 (13), 2006 (10), 2007 (11)
Guinea 84820 90 2001 (2), Est. 2006 (8)
Guinea-Bissau n/a 1 Est. 2006 (8)
Ivory Coast 527670 47 1998 (1), Est. 2006 (8)
Kenya ~1650 2 1999 (6), 2000 (5)
Mali 46868 19 1998 (1), 2000 (5), Est. 2006 (8), 2007 (12)
Mauretanien 13055 5 Est. 2006 (8), 2007 (12)
Niger 49868 19 Est. 2006 (8)
Nigeria ~32000 3 1998 (1)
Ruanda 1695648 214 2000 (4), 2004 (7)
Senegal 308563 130 1998 (1), 2000 (5), Est. 2006 (8)
South Africa n/a 5 2000 (5)/(13)
Tanzania n/a 6 1999 (6), 2001 (2), 2007 (11)
Togo 20011 12 2000 (5), Est. 2006 (8)
Uganda n/a 5 1999 (6), 2000 (5), 2007 (11)

Sources

  1. Atim, Chris. 1998. The Contribution of Mutual Health Organizations to Financing, Delivery, and Access to Health Care: Synthesis of Research in Nine West and Central African Countries. Technical Report No. 18. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc.
  2. Arhin-Tenkorang, Dyna. 2001. Health Insurance for the Informal Sector in Africa. Design Features, Risk Protection, and Resource Mobilization. HNP Working Papers. The World Bank, Washington, D.C.
  3. Criel, Bart. 1998. District-based Health Insurance in sub-Saharan Africa. Studies in Health Services Organisation & Policy 9.
  4. Diop, Francois, Pia Schneider, Damascene Butera. September 2000. Summary of Results: Prepayment Schemes in the Rwandan Districts of Byumba,Kabgayi, and Kabutare. Technical Report No. 59. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc.
  5. International Labour Organization (ILO). 2000. Health Micro-insurance -  A Compendium. Working Paper, STEP-Programme, Geneva.
  6. Musau, Stephen N. August 1999. Community-Based Health Insurance: Experiences and Lessons Learned from East and Southern Africa. Technical Report No. 34. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc.
  7. Ndahinyuka,  Jovit. 2004. Etude de cas sur les rôles des acteurs dans le développement des mutuelles de santé au Rwanda. Abt. Associations.
  8. Ndiaye, Pascal, Werner Soors, and Bart Criel. 2007. Editorial: A view from beneath: Community Health Insurance in Africa. Tropical Medicine and International Health 12(2):157–161.
  9. Moutade Naimbaye, Thomas. 2003. Inventaire des systèmes d’assurance maladie en Afrique - Rapport du Tchad. Senegal
  10. Preker, Alexander, Richard M. Scheffler, and Mark C. Bassett. 2006. Private Voluntary Health Insurance in Development – Friend or Foe? The World Bank, Washington, D.C.
  11. Roth, Jim, Michael J. McCord and Dominic Liber. 2007. The Landscape of Microinsurance in the Wolrd's 100 Poorest countries. The Microinsurance Center, LLC, Appleton.
  12. Sulzbach, Sara, Bertha Garshong, and Gertrude Owusu-Banahene. 2005. Evaluating the Effects of the National Health Insurance Act in Ghana: Baseline Report. USAID and PHRplus, Abt. Associations.
  13. Soederlund, Neil, and Birgit Hansl. Health insurance in South Africa: an empirical analysis of trends in risk-pooling efficiency following deregulation. Health Policy and Planning 15(4):378-385.