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"To enrol or not to enrol?": A qualitative investigation of demand for health insurance in rural West Africa

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  • De Allegri, Manuela
  • Sanon, Mamadou
  • Sauerborn, Rainer

Abstract

In spite of the fact that feeble levels of participation have long been identified as a major constraint to the successful long-term implementation of community-based health insurance (CBI) in low-income countries, evidence on determinants of enrolment in CBI is still lacking. The application of econometric modelling has provided a partial answer to the question, but on its own it has proved to be insufficient to guide policy making. This paper aims to fill this gap in knowledge using qualitative research methods. In-depth interviews with 32 household heads were conducted in the Nouna Health District, Burkina Faso, West Africa to assess determinants of enrolment in a newly established CBI scheme. The findings highlight that factors previously neglected in the literature, such as institutional rigidities and socio-cultural practices, play an important role in shaping the decision to enrol. The discussion of the findings focuses on the policy implications, offering concrete recommendations to maximise enrolment, within and beyond Burkina Faso.

Suggested Citation

  • De Allegri, Manuela & Sanon, Mamadou & Sauerborn, Rainer, 2006. ""To enrol or not to enrol?": A qualitative investigation of demand for health insurance in rural West Africa," Social Science & Medicine, Elsevier, vol. 62(6), pages 1520-1527, March.
    • Handle: RePEc:eee:socmed:v:62:y:2006:i:6:p:1520-1527
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    References listed on IDEAS

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    1. Dong, Hengjin & Kouyate, Bocar & Snow, Rachel & Mugisha, Frederick & Sauerborn, Rainer, 2003. "Gender's effect on willingness-to-pay for community-based insurance in Burkina Faso," Health Policy, Elsevier, vol. 64(2), pages 153-162, May.
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    6. Dong, Hengjin & Mugisha, Frederick & Gbangou, Adjima & Kouyate, Bocar & Sauerborn, Rainer, 2004. "The feasibility of community-based health insurance in Burkina Faso," Health Policy, Elsevier, vol. 69(1), pages 45-53, July.
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    Cited by:

    1. Aggrey Mavis & Opuni Frimpong Frank & Dr. Nkum Bernard, 2014. "Time as a determinant for National Health Insurance Scheme Subscriber Health Care Utilization," Journal of Social Sciences (COES&RJ-JSS), , vol. 3(3), pages 399-407, July.
    2. Khaled Makhloufi & Bruno Ventelou & Mohammad Abu-Zaineh, 2015. "Have health insurance reforms in Tunisia attained their intended objectives?," International Journal of Health Economics and Management, Springer, vol. 15(1), pages 29-51, March.
    3. Abiiro, Gilbert Abotisem & Torbica, Aleksandra & Kwalamasa, Kassim & De Allegri, Manuela, 2014. "Eliciting community preferences for complementary micro health insurance: A discrete choice experiment in rural Malawi," Social Science & Medicine, Elsevier, vol. 120(C), pages 160-168.
    4. Thomas Rouyard & Yukichi Mano & Bocar Mamadou Daff & Serigne Diouf & Khadidiatou Fall Dia & Laetitia Duval & Josselin Thuilliez & Ryota Nakamura, 2022. "Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal," Post-Print halshs-03641124, HAL.
    5. Agier, Isabelle & Ly, Antarou & Kadio, Kadidiatou & Kouanda, Seni & Ridde, Valéry, 2016. "Endorsement of universal health coverage financial principles in Burkina Faso," Social Science & Medicine, Elsevier, vol. 151(C), pages 157-166.
    6. Fink, Günther & Robyn, Paul Jacob & Sié, Ali & Sauerborn, Rainer, 2013. "Does health insurance improve health?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1043-1056.
    7. Basaza, Robert & Criel, Bart & Van der Stuyft, Patrick, 2008. "Community health insurance in Uganda: Why does enrolment remain low? A view from beneath," Health Policy, Elsevier, vol. 87(2), pages 172-184, August.
    8. Wood, Anna, 2023. "Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal," Social Science & Medicine, Elsevier, vol. 319(C).
    9. Bocoum, Fadima & Grimm, Michael & Hartwig, Renate & Zongo, Nathalie, 2019. "Can information increase the understanding and uptake of insurance? Lessons from a randomized experiment in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 220(C), pages 102-111.
    10. Chantal Herberholz & Wael Ahmed Fakihammed, 2017. "Determinants of Voluntary National Health Insurance Drop-Out in Eastern Sudan," Applied Health Economics and Health Policy, Springer, vol. 15(2), pages 215-226, April.
    11. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    12. Dong, Hengjin & De Allegri, Manuela & Gnawali, Devendra & Souares, Aurélia & Sauerborn, Rainer, 2009. "Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso," Health Policy, Elsevier, vol. 92(2-3), pages 174-179, October.
    13. Robyn, Paul Jacob & Bärnighausen, Till & Souares, Aurélia & Traoré, Adama & Bicaba, Brice & Sié, Ali & Sauerborn, Rainer, 2014. "Provider payment methods and health worker motivation in community-based health insurance: A mixed-methods study," Social Science & Medicine, Elsevier, vol. 108(C), pages 223-236.
    14. Ridde, Valery & Haddad, Slim & Yacoubou, Moussa & Yacoubou, Ismaelou, 2010. "Exploratory study of the impacts of Mutual Health Organizations on social dynamics in Benin," Social Science & Medicine, Elsevier, vol. 71(3), pages 467-474, August.
    15. Nikièma, Béatrice & Haddad, Slim & Potvin, Louise, 2008. "Women Bargaining to Seek Healthcare: Norms, Domestic Practices, and Implications in Rural Burkina Faso," World Development, Elsevier, vol. 36(4), pages 608-624, April.
    16. Pokhrel, Subhash & De Allegri, Manuela & Gbangou, Adijma & Sauerborn, Rainer, 2010. "Illness reporting and demand for medical care in rural Burkina Faso," Social Science & Medicine, Elsevier, vol. 70(11), pages 1693-1700, June.
    17. Mladovsky, Philipa, 2014. "Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal," Social Science & Medicine, Elsevier, vol. 107(C), pages 78-88.
    18. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    19. Juliette Alenda-Demoutiez & Bruno Boidin, 2019. "Community-based mutual health organisations in Senegal: a specific form of social and solidarity economy?," Post-Print hal-02400072, HAL.

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