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[ Recorded presentation ] Recorded presentation

Community health insurance: Assessment and program implementation in rural Togo

Francis Sala-Diakanda, MPH1, Grazielle Ghesquiere2, Bell'Aube Houinato1, and Luis Tam, MD DrPH3. (1) Plan Togo, Angle Bd Jean Paul II, Rue 159 Tokan Wuiti, BP 3485, Lome, Togo, 232-22242067, luis.tam@planusa.org, (2) Louvain Development, c/o Plan Togo, Lome, Togo, (3) Plan USA, 1730 N Lynn St Suite 600, Arlington, VA 22209

BACKGROUND: Only 25% of the population in Togo (West Africa) has access to basic health services, despite the country's participation in the Bamako Initiative of community management and financing of health facilities. Togolese stakeholders claim that one of the major reasons is the people's inability to afford the cost of drugs and services. GOAL: A participatory assessment of the capacity to pay for basic health services was conducted among the inhabitants of 25 rural villages in the Central and Plateaux regions of the country. They comprise 10% of the intervention area of Plan Togo, a humanitarian, international NGO. METHODS: 75 Focus group discussion with adults and children, sample survey to 415 households, semi-structured interviews with opinion leaders and health care providers. RESULTS: Financial barriers limit the access to basic health care. Only 20% of the heads of household were able to purchase the drugs prescribed at the regional and district hospitals, and only 40% of prescriptions at the Peripheral Health Unit (PHU: the first level facility at the village). 11% of households borrow from their families and 22% sell some of the agricultural production or livestock. More worryingly, 4.5% of households ‘pledge their children', i.e. they send the child off to work in order to repay the borrowed money. The study also found that families were enthusiastic about setting up a “social security fund” to address this barrier. CONSEQUENCES: Based on this study, Plan Togo and its partners have developed a community health insurance project with four major results: (a) functional and self managed health insurance schemes provide the communities with the financial coverage of their health care costs, in particular those of their children, (b)the communities have improved their capacity to manage health care issues, (c) the improvement of the quality of the health care system, and (d)partners have improved their capacity to support the communities in the local management of health issues. This project is funded by Plan Togo and local organizations (including government agencies) plus contributions from participating families. The author will discuss the strategies and results of this program during his presentation.

Learning Objectives:

Presenting author's disclosure statement:

Any relevant financial relationships? No

[ Recorded presentation ] Recorded presentation

Community Health Insurance and Health Care Financing in Decentralized Health Systems

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA