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


  • Doris Wiesmann
  • Johannes Jütting


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.

Suggested Citation

  • Doris Wiesmann & Johannes Jütting, 2000. "The emerging movement of community based health insurance in sub-Saharan Africa: Experiences and lessons learned," Africa Spectrum, Institute of African Affairs, GIGA German Institute of Global and Area Studies, Hamburg, vol. 35(2), pages 193-210.
  • Handle: RePEc:gig:afjour:v:35:y:2000:i:2:p:193-210

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    Cited by:

    1. Sanderson, Marie & Allen, Pauline & Moran, Valerie & McDermott, Imelda & Osipovic, Dorota, 2020. "Agreeing the allocation of scarce resources in the English NHS: Ostrom, common pool resources and the role of the state," Social Science & Medicine, Elsevier, vol. 250(C).
    2. Habtom, GebreMichael Kibreab & Ruys, Pieter, 2007. "Traditional risk-sharing arrangements and informal social insurance in Eritrea," Health Policy, Elsevier, vol. 80(1), pages 218-235, January.
    3. Jutting, Johannes Paul, 2002. "Die neue Rolle von Sozialer Sicherung für ländliche Entwicklung in Entwicklungsländern," German Journal of Agricultural Economics, Humboldt-Universitaet zu Berlin, Department for Agricultural Economics, vol. 51(04), pages 1-9.
    4. Hermann Donfouet & Pierre-Alexandre Mahieu & Eric Malin, 2013. "Using respondents’ uncertainty scores to mitigate hypothetical bias in community-based health insurance studies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 277-285, April.
    5. Rajeev Ahuja & Johannes Jutting, 2004. "Are the poor too poor to demand health insurance?," Indian Council for Research on International Economic Relations, New Delhi Working Papers 118, Indian Council for Research on International Economic Relations, New Delhi, India.
    6. Ahuja, Rajeev & Jutting, Johannes Paul, 2003. "Are The Poor Too Poor To Demand Health Insurance?," 2003 Annual Meeting, August 16-22, 2003, Durban, South Africa 25821, International Association of Agricultural Economists.
    7. 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.
    8. Dror, David Mark & Koren, Ruth & Ost, Alexander & Binnendijk, Erika & Vellakkal, Sukumar & Danis, Marion, 2007. "Health insurance benefit packages prioritized by low-income clients in India: Three criteria to estimate effectiveness of choice," Social Science & Medicine, Elsevier, vol. 64(4), pages 884-896, February.
    9. Sachiko Ozawa & Simrun Grewal & John F.P. Bridges, 2016. "Household Size and the Decision to Purchase Health Insurance in Cambodia: Results of a Discrete-Choice Experiment with Scale Adjustment," Applied Health Economics and Health Policy, Springer, vol. 14(2), pages 195-204, April.

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