Comprehensive assessment of the impact of mandatory community-based health insurance in Burkina Faso

Health coverage for informal workers in Sub-Saharan Africa remains a major challenge. This study evaluates an alternative approach: bundling health insurance with microcredit. We conducted a randomized controlled trial in Ouagadougou, Burkina Faso, to assess the impact of mandatory health insurance linked to microcredit. The study covered 88 microcredit groups (44 treated, 44 control), analyzing outcomes for 1,095 individuals who reported illness episodes in the six months preceding the final survey in January–February 2022. Results show that the insurance requirement did not lead to program dropout, with loan renewal rates remaining stable between groups. Health insurance had a significant positive impact on financial protection: out-of-pocket expenses decreased by over 50% and payment difficulties by 36%. The study also reveals changes in health-seeking behaviors. Use of modern healthcare facilities increased by 7%, while reliance on traditional medicine decreased by 61%. Insured individuals also sought care more quickly, with 23% more seeking care on the same day symptoms appeared. However, no significant impact was observed on physical or psychological health outcomes. These findings suggest that bundling health insurance with other services like microcredit can be a viable solution for deploying mandatory health coverage to populations working in the informal sector. This approach provides significant financial protection against health risks and improves access to healthcare.