WWW.BOOK.DISLIB.INFO
FREE ELECTRONIC LIBRARY - Books, dissertations, abstract
 
<< HOME
CONTACTS



Pages:     | 1 |   ...   | 64 | 65 || 67 | 68 |   ...   | 108 |

«Protecting the poor A microinsurance compendium Edited by Craig Churchill Protecting the poor A microinsurance compendium Protecting the poor A ...»

-- [ Page 66 ] --

Community-based health insurance is not a theoretical model. It has been a pioneering approach to extending social protection since its development began more than 15 years ago. Based on several studies2 and on the experience of external support organizations active in this field (particularly the ILO’s STEP programme and the French NGO CIDR), this chapter explains past and current developments in this specific model.

This chapter is divided into six sections. The first section describes a specific community-based model, the mutual health organization (MHO) and its theoretical application in West Africa. The second section provides information on the proliferation of this model in West Africa while few other approaches have been tested in the region. Section 3 briefly examines the target group of MHOs in West Africa. The next section explores strategic questions, namely: do the mutual health organizations function (well) and are they having an impact? To explain some observations made in this fourth section, section 5 examines the specific origins of the problems described.

Finally, the last section illustrates the intrinsic added value of the community-based model.

–  –  –

1 What is a community-based model?

It is difficult to give a standard definition of community-based microinsurance. Literature on the subject has almost as many definitions of the model as there are community-based organizations (CBOs) or specialists. In practice, various insurance schemes containing some community-based elements have been experimented with throughout the world. Uganda has tried several systems governed and managed by hospitals involving community groups in the design of benefit packages and collection of premiums (Dierrennic et al., 2005). Tanzania is implementing a nationwide system called the Community Health Fund (CHF). Members are organized in management committees, which include the healthcare managers, although the rules of the CHF (including the premium amount) are fixed by district authorities (Musau, 1999). Another way of managing health microinsurance is through MFIs. If an MFI is community based, which is to say organized as a mutual like AssEF in Benin, its microinsurance scheme could be included in the community-based model.

A few NGOs have experimented with health microinsurance managed by professionals, which shares the objectives and features of a community-based model. For example, in the SKY programme launched by the French NGO GRET in Cambodia, professionals employed by the NGO manage the scheme. Clients in village committees are regularly consulted to ensure that the scheme is accountable to the policyholders (CIDR, 2005).

Notwithstanding this variety of community-based insurance schemes, this chapter focuses on one particular type: the mutual health organization or mutuelle de santé. The main geographical reference is West Africa because this model is most common in this region (Tabor, 2005).3 Mutual health organizations were originally developed in Europe in the 19th century where workers’ organizations set up mutual funds to improve access to healthcare in the absence of other kinds of social protection. In several countries, these initiatives have contributed significantly to the implementation of a social protection policy at the national level.

1.1 Essential features The essential features of MHOs demonstrate their strong community-based

nature and reflect the purposes and operations of the model:

–  –  –

– Improve access to healthcare through risk-sharing and resource-pooling – Not-for-profit – Mutual-interest organizations based on groups sharing common characteristics – Members are owners and beneficiaries at the same time – Participatory decision-making – Voluntary membership – Promotion of solidarity, democracy and social cohesion – Potential functions beyond insurance Like other insurance systems, mutual heath organizations are based on a mechanism of risk-sharing and resource-pooling. However, more specifically, these organizations are non-profit and do not select their members on the basis of their individual risk profiles. Access to healthcare through solidarity is thus the main objective of these organizations.

The members of mutual health organizations are the owners, the decision-makers and the policyholders, which strongly differentiates this model from other insurance schemes. This feature requires strong participation and control mechanisms to make collective decision-making effective. Annual general meetings decide on issues such as budgets, accounts, what to do with surpluses, and operational matters as well as overall strategy. Members govern their MHOs through elected representatives, who are responsible for implementing control mechanisms, such as monitoring the implementation of internal rules, controlling financial flows and collecting complaints relating to the service provided.

Membership is voluntary. This principle clearly distinguishes MHOs from compulsory insurance schemes such as most national and often staterun social security systems. As in any non-profit organization, a person may choose to become a member but is never forced to join.

In most MHOs, members share some common characteristics, such as being members of the same organizations, inhabitants of the same village or workers in the same trade, often because they are built on an existing organization (see Box 72). Bearing in mind that membership is voluntary, an MHO has to find a way of ensuring that it can gather a “sufficient” number of members to run the risk-sharing mechanisms in an efficient and attractive way: the larger the group, the greater the benefits for the members. Being organized in a (formal or informal) pre-existing group facilitates this process.





In addition, sharing some characteristics, or better, being previously involved in similar collective decision-making mechanisms with the same group, facilitates the functioning of an MHO.

The community-based model: Mutual health organizations in Africa 381

Profiles of initiating organizations of MHOsBox 72

In Burkina Faso, the Association Yekouma Dakoupa and the Association of Widows and Orphans from the Leere (Association des Veuves et Orphelins du Leere) offer a range of services such as agricultural support, microcredit and school fees for orphan children. A group of women organized an informal solidarity fund to help members and their families when facing a health event. Worried that this fund would not be sufficient to cover all needs and health expenses, they decided to set up a more sustainable system. They contacted the STEP programme with whom they set up a mutual health organization called Leere Laafi Bolem in 2001.

In the case of the Lalane Diassap MHO in Senegal, a village youths’ organization (Association des Jeunes de Lalane) took the initiative to launch a village-based mutual health organization in the mid-nineties. Staff already working with other mutual health organizations in the Thiès Region helped to launch this initiative.

In the case of the Mutuelle de Fatako (Guinea Conakry), a women’s association (Association des Femmes Ressortissantes de Fatako) identified access to healthcare as a major problem for Fatako inhabitants. Together with the STEP Programme and the Association Guinéenne de Bien-Etre Familial (ASBEF), they created a mutual health organization in 2002.

Source: Adapted from Fonteneau et al., 2004 and Fonteneau, 2004.

MHOs actively promote some ideals like solidarity, democracy or social cohesion. These values are particularly important for the resource-pooling and risk-sharing of microinsurance, since members’ familiarity with each other can assist in controlling moral hazard and fraud, and can encourage renewals.

However, unlike other insurance providers, an MHO cannot be reduced to its insurance function. As participatory, mutual-interest organizations, MHOs fulfil functions beyond insurance. For instance, the MHOs objectives almost always include health education. They also act in a sector (healthcare) where the interests of users have only recently been represented.

By organizing potential users of health services, MHOs can represent their interests to healthcare providers. In the same way, since the state is a key actor in healthcare systems, MHOs can represent the population in policy discussions. For example, these community-based organizations may lobby on health financing issues and participate in social protection reform processes (see Chapter 1.3).

382 Institutional options

1.2 Consequential features Apart from these essential features, other characteristics are also worth mentioning to provide a more complete picture of the MHO model. These features are “consequential” in the sense that they result from the model, but are not inherent characteristics.

The setting-up of an MHO often implies the creation of a new organization even when an existing organization takes the initiative to start a microinsurance scheme. In other models, insurance can indeed be developed as a product offered and managed by an existing institution (e.g. MFIs or insurance companies). In the case of an MHO, the insurance scheme is the organization. The new organization created for the purpose of providing insurance leads to an institutionalization process that requires extra effort from the initiating organizations and/or from external support providers.

The MHO schemes are managed and controlled by members who financially contribute to them. This does not mean that an MHO has to be selfmanaged, but in reality this is often the case. Managers, who are members themselves, are elected or designated by the members of the insurance schemes. They often fulfil this function on a voluntary and unpaid basis. Voluntary “self-management” is one way to ensure continuity between the members and the institutions, and avoid conflicts between the management and the beneficiaries. However, voluntary, unpaid jobs are also chosen out of necessity due to the lack of resources. This practice reduces the costs of the insurance product, but is not a long-term solution.

As mentioned earlier, microinsurance schemes consist of members sharing some common characteristics. This feature ensures the necessary minimum level of trust and social cohesion to set up and run an MHO according to the features described (i.e. self-management, a collective decision-making process, participatory mechanisms, risk-sharing). Especially in the beginning, the membership of an MHO is often homogenous, which can have negative effects due to a lack of risk diversification. Such a situation also has a limited ability to achieve vertical solidarity, which allows for cross-subsidization between richer and poorer people.

2 Why was/is this approach implemented in West Africa?

The existence and implementation of MHOs in Africa did not occur by chance. African MHOs first appeared in the late 1980s and early 1990s, coinciding with two developments: 1) the democratization process and 2) the implementation of the Bamako Initiative.

The community-based model: Mutual health organizations in Africa 383 In many African countries, the late 1980s represented the beginning of democratization and the emergence of a civil society. As a result, many initiatives were undertaken by the population to respond to urgent needs and political issues. These initiatives were encouraged by development cooperation agencies that wanted to support the democratization process. In this context, the associational affiliation of MHOs as non-profit, autonomous, mutual-interest organizations was an easy and flexible way to launch a collective initiative.

During the 1990s, the Bamako Initiative (launched in 1987 by the World Health Organization and UNICEF) was also progressively implemented.

Designed to secure universal access to quality primary healthcare, the Bamako Initiative rests on three principles. First, primary healthcare services must attain a sufficient level of self-financing, which requires patients to contribute through user fees. The second is the principle of better access to medicines, particularly generic pharmaceuticals. The third principle is community participation to enhance the quality of care. If representatives from the local community sit on the boards of the healthcare centres, this will make the providers more transparent and responsive. This last principle recognizes that a range of actors should be involved in the healthcare system, including community-based organizations.



Pages:     | 1 |   ...   | 64 | 65 || 67 | 68 |   ...   | 108 |


Similar works:

«Velika Hoca Management Plan Restoration of Vineries and Lodgings Predrag Nicic Architect Ministry of Culture, Pristina, Kosovo nicic.pedja@krstarica.com Abstract This project is based on animation of mechanisms of urgent legal, technical and socioeconomic protection of heritage and creating a network of experts and NGOs on gathering and exchangeing of information about protection of heritage, organization of projects and realization of urgent selected buildings protection, preservation and...»

«ASCEND Health-Related Community-Based Participatory Research Small Grants Request for Proposals I. OVERVIEW INFORMATION Participating The Morgan State University ASCEND project. Organizations: Fusion Partnerships, Inc. Announcement RFP-ASCEND-2016-1 Number: Funding To fund small health-related community-based participatory research projects, led Opportunity collaboratively by Morgan State University faculty, post-doctoral fellows or Purpose (in doctoral students in partnership with a...»

«12727Page 1 of 27 THE UK ASSET RECOVERY REGIME Introduction This presentation is divided into two parts: 1. An outline of the domestic asset recovery regime;2. An overview of the way in which the UK can assist overseas jurisdictions There has been a confiscation regime in England and Wales since 1986 when the Drug Trafficking Offences Act came into force to confiscate the proceeds of drug trafficking. Since then there have been a number of subsequent pieces of legislation enacted with the...»

«DE EVOLVE® TRIAD™ BONE SCREWS 150874-0 Dieses Paket enthält die folgenden Sprachen: English (en) Deutsch (de) Nederlands (nl) Français (fr) Español (es) Italiano (it) Português (pt) 中文Chinese (sch) Türkçe (tk) Weitere Sprachen finden Sie auf unserer Website www.wmt.com Klicken Sie dann auf die Option Verschreibungsinformationen. Wenden Sie sich für zusätzliche Informationen und Übersetzungen bitte an den Hersteller oder an den lokalen Vertriebspartner. M P C 0086* Wright...»

«PEOPLE WITH Recruiting, Hiring, Retaining, DISABILITIES and Promoting A RESOURCE GUIDE FOR EMPLOYERS A Product of the Curb Cuts to the Middle Class Initiative February 3, 2015 This resource guide is a product of the Curb Cuts to the Middle Class Initiative, a federal crossagency effort working to increase equal employment opportunities and financial independence for individuals with disabilities. The Curb Cuts to the Middle Class Initiative includes participation by agencies across the federal...»

«Die Degradation der organischen Dentinmatrix durch Pepsin unter erosiven Bedingungen in vitro Inauguraldissertation zur Erlangung des Grades eines Doktors der Zahnmedizin des Fachbereichs Medizin der Justus-Liebig-Universität Gießen Vorgelegt von Martin Jens Merz aus Bad Soden-Salmünster Gießen 2010 Aus dem Medizinischen Zentrum für Zahn-, Mundund Kieferheilkunde Poliklinik für Zahnerhaltungskunde und Präventive Zahnheilkunde Leitung: Prof. Dr. Joachim Klimek des Universitätsklinikums...»

«March 10, 2013 The Right Honourable Stephen Harper Prime Minister of Canada pm@pm.gc.ca The Honourable Leona Aglukkaq Minister of Health, Health Canada minister_ministre@hc-sc.gc.ca Ms Kathleen Wynne Premier of Ontario kwynne.mpp@liberal.ola.org kwynne.mpp.co@liberal.ola.org Mr. Robert Hornung President of the Canadian Wind Energy Association roberthornung@canwea.ca Copy: David S. Michaud, PhD Principal Investigator, Wind Turbine Noise Study Consumer and Clinical Radiation Protection Bureau...»

«LEE COUNTY POCKET GUIDE TO EMERGENCY ASSISTANCE Lee County Homeless Coalition 1500 Colonial Boulevard, Suite 235 Fort Myers, Florida 33907 (239) 322-6600 www.leehomeless.org This guide was prepared to help those who find themselves homeless or in immediate need of some sort of assistance. It does not contain all the services which may be available to assist you or guarantee services are still available. Our sincere hope is that it will connect you with someone who can be of assistance. This...»

«IHI Triple Aim Improvement Community A 10-Month Collaborative Learning Opportunity September 2013-June 2014 Executive Summary The concept of better health, better health care, and lower per capita cost has become an emboldening principle for health system improvement around the world. The Institute for Healthcare Improvement (IHI), which pioneered the Triple Aim concept, invites you to join the IHI Triple Aim Improvement Community beginning in September 2013. Based on IHI’s expertise in...»

«Aus dem Institut für Zytobiologie Geschäftsführender Direktor: Prof. Dr. Roland Lill des Fachbereichs Medizin der Philipps-Universität Marburg Identifizierung und Charakterisierung neuer Faktoren der zytosolischen Fe-S Proteinbiogenese Inaugural-Dissertation zur Erlangung des Doktorgrades der Naturwissenschaften (Dr. rer. nat.) dem Fachbereich Medizin der Philipps-Universität Marburg vorgelegt von Viktoria Désirée Paul aus Wetzlar Marburg, 2014 Angenommen vom Fachbereich Medizin der...»





 
<<  HOME   |    CONTACTS
2016 www.book.dislib.info - Free e-library - Books, dissertations, abstract

Materials of this site are available for review, all rights belong to their respective owners.
If you do not agree with the fact that your material is placed on this site, please, email us, we will within 1-2 business days delete him.