The emerging movement of community based health insurance in sub-Saharan Africa: Experiences and lessons learned

The majority of Sub-Saharan African citizens - informal sector workers and the rural population - have never had access to wage-based social health insurance or privately run health insurance. As a response to the lack of social security, to the negative side-effects of user fees introduced in the eighties and to persistent problems with health care financing, non-profit, voluntary community-based health insurance (CBHI) schemes for urban and rural self-employed and informal sector workers have recently emerged. CBHI seems to be a promising attempt to improve access to health care, health outcomes and social protection in the case of illness. Given the unique ethnic, lingual and cultural diversity within African nations, the CBHI approach may be particularly valuable because it allows adaptation to local conditions. The actual implementation of CBHI schemes in Sub-Saharan Africa has had mixed results so far, with viability and acceptance largely depending on design and management of the scheme, community participation, regulations at the level of the health care provider, quality of services and on the socio-economic and cultural context. As it has turned out that small-scale health insurance can supplement other sources of finance rather than being a substitute for them, public-private partnerships may provide scope for improvement of CBHI performance.