A framework for success: Comparative analysis of African community based health insurance initiatives

The Authors compared experiences in expanding health insurance through community based schemes across six Sub Saharan African countries: Ghana, Rwanda, Senegal, Benin, Cameroon and Niger. These experiences were studied based on an analytical framework including quantitative, functional, political and organizational aspects to health insurance scale up, the success in improving financial access to care and the remaining challenges.

Senegal and Benin were among the first countries where community mutual health organizations (MHOs) emerged in Africa. MHOs in Ghana and Rwanda developed in the late 1990s, supported by lessons learned on self-management and community participation from MHO experiences in French-speaking countries. However, in the expansion of MHO-based health insurance, Ghana and Rwanda quickly moved ahead of Francophone Sub-Saharan African and many other developing countries. Consequently, their experiences are now considered full-size laboratories for the expansion of health insurance.

Lessons are drawn from this comparison to highlight factors which lead to effective rapid scale up in Ghana and Rwanda and the authors discuss the continued opportunities to do the same in other Sub Saharan African countries.