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

Abstract #69242

Learning Objectives:

Learning Objectives 1. To assess the feasibility and opportunities of credit insurance plan in improving utilization of health care among poor rural communities 2. To discuss potential possibilities of adopting this system into other programs In 1999, Madagascar introduced a cost-recovery strategy at the health center level; community played a lead role in planning for the sustainability. Medical Care Development International’s Child Survival Project in Betioky-Sud district assisted one of its 19 communities in developing and testing a model. Procedures: Reviewed the previous experience with cost recovery and community financing, and analyzed household income, expenditure and health care consumption data. An insurance scheme and a credit plan, were presented to the community, which chose the second. Executive Committees of the Community Health Associations developed a budget and service pricing. Executive Committees enrolled new members; managed village collateral fund; collected payments; and enforced member compliance. Results: The system comprised of approximately 2076 members (coverage 61%), paying a one-time membership fee equivalent to 40 cents US. Average credit is 77 cents US, repaid in two weeks. PHC attendance increased from 40% to 149%. Members had easy access to cash for treatment, without borrowing at high rates of interest. Adherence to prescriptions increased from 20% to almost 100%. Overpricing for MCH services fixed through price adjustment for medicines and treatments. Repayment rate is 91% and the plan functioned during the 6-month political crisis in year 200
• When the MOH stopped cost-recovery schemes, the community used their fund to purchase medicines.

Keywords: International Public Health, Access to Health Care

Presenting author's disclosure statement: