The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #66391

Pascale Mantoura, MSc, PhD Student, Unité de santé internationale, Université de Montréal, C.P. 6128 Succ. Centre-Ville, Montréal, QC H3C 3J7, Canada, (514)343-6111 #1281, pascale.mantoura@UMontreal.CA

In a context of absence of universal insurance, deficient financing of health services, pro efficiency reforms neglecting equity, and slow economic growth, inequalities in access to health care services have increased in low income countries, often to the point of exclusion from care of some segments of the population.

In recent years, particularly in Africa, many community-based health insurance schemes (CBHIS) have emerged, mostly in a top-down fashion, with the main objectives of favouring access to care of acceptable quality, and raising significant amounts of revenue for the health sector. Their sustainability and ability to actually provide the poor with solutions to the insurance deficit and mainly to access health care of acceptable quality are debated.

This presentation’s objective is to analyse the adequacy between rhetorical expectations of CBHIS and African realities. Methods will consist of a comparison between practical experiences in West African countries and externally shaped key concepts and objectives underlying CBHIS. Results will present 1) principles behind CBHIS, 2) experiences in West African countries, and 3) discrepancies between African realities and rhetorical expectations. Conclusions will demonstrate that CBHIS’s designs are not adapted to African realities, thereby limiting their ability to facilitate access to health care of the most deprived segments of the population. In terms of policy implications, in order to reduce inequalities in access to health care in Africa, we will suggest that implementation of CBHIS must be complemented by enabling population-based approaches.

Learning Objectives:

At the conclusion of the session, the participant in this session will be able to : 1)acquire an understanding of the objectives and underlying key concepts (insurance principles, community participation, community management, solidarity and trust) of community-based health insurance schemes; 2)describe African realities in relation to practical implementation of schemes;
• recognize limits of schemes vis-a-vis African realities; 4)evaluate the value of complementary approaches to CBHIS implementation.

Keywords: Community Programs, Access to Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.