La difficulté du partenariat entre professionnels de santé et mutualistes: le cas de la mutuelle de santé Maliando en Guinée‐Conakry

Criel, Bart; Diallo, Alpha Ahmadou; Vennet, Jean Van der; Waelkens, Maria-Pia; Wiegandt, Axel

doi:10.1111/j.1365-3156.2005.01410.x

Cited by 20 publications

(16 citation statements)

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“…It is possible that the participatory dynamic in CBHI empowered members to successfully demand good quality care, as proposed in other literature on CBHI (Criel et al, 2005;Michielsen et al, 2011;Schneider, 2005;Waelkens & Criel, 2007).…”

Section: Discussionmentioning

confidence: 92%

“…To provide a conceptual framework to guide the analysis, examples of active community participation in CBHI identified in the literature on sub-Saharan Africa (Atim, 1999;Basaza et al, 2007;Criel et al, 2005;Criel & Waelkens, 2003;De Allegri et al, 2006;Ridde et al, 2010;Schneider, 2005;Waelkens & Criel, 2007) are categorised according to Rifkin's (1986) framework (Table 1).…”

Section: Objectives Of the Studymentioning

confidence: 99%

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Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Mladovsky¹

2014

Social Science & Medicine

116

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AcknowledgementsThe author would like to thank Bart Criel, Pascal Ndiaye, Alfed Ndiaye, Werner Soors and all national stakeholders in Senegal for their contributions to the research project, the team of fieldwork assistants and supervisors, staff of the three CBHI schemes who gave up their time to facilitate the research, all the interviewees who also gave their time, the Institute of Tropical Medicine, Antwerp and the Stewart Halley Trust for providing funding for the research, and the two anonymous reviewers who provided valuable comments and insights. AbstractAlthough a high level of drop-out from community-based health insurance (CBHI) is frequently reported, it has rarely been analysed in depth. This study explores whether never having actively participated in CBHI is a determinant of drop-out. A conceptual framework of passive and active community participation in CBHI is developed to inform quantitative data analysis. Fieldwork comprising a household survey was conducted in Senegal in 2009. Levels of active participation among 382 members and ex-members of CBHI across three case study schemes are compared using logistic regression. Results suggest that, controlling for a range of socioeconomic variables, the more active the mode of participation in the CBHI scheme, the stronger the statistically significant positive correlation with remaining enrolled. Training is the most highly correlated, followed by voting, participating in a general assembly, awareness raising / information dissemination and informal discussions / spontaneously helping. Possible intermediary outcomes of active participation such as perceived trustworthiness of the scheme management / president; accountability and being informed of mechanisms of controlling abuse/fraud are also significantly positively correlated with remaining in the scheme. Perception of poor quality of health services is identified as the most important determinant of drop-out. Financial factors do not seem to determine drop-out. The results suggest that schemes may be able to reduce drop-out and increase quality of care by creating more opportunities for more active participation. Caution is needed though, since if CBHI schemes uncritically fund and promote participation activities, individuals who are already more empowered or who already have higher levels of social capital may be more likely to access these resources, thereby indirectly further increasing social inequalities in health coverage.

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Section: Discussionmentioning

confidence: 92%

Section: Objectives Of the Studymentioning

confidence: 99%

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Mladovsky¹

2014

Social Science & Medicine

116

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“…Previous studies have shown that health workers’ dissatisfaction with payment mechanisms in CBI can lead to low coverage, because health workers can influence the uptake of insurance in the population from which they draw their patients [13,26,43,44]. Our results provide new information about how health workers in Burkina Faso value different provider payment mechanisms in the context of a CBI scheme, where coverage has been low since the inception of the scheme, and there is strong evidence that health worker dissatisfaction with the scheme has contributed to the low coverage.…”

Section: Discussionmentioning

confidence: 99%

“…In turn, the perception in the community that CBI enrollees receive worse-quality care than other patients (e.g., less friendly reception by health workers and lower quantities of drugs) is likely to have been a major cause of the low CBI coverage observed [23,25]. Studies in other settings have also shown that provider payment mechanisms are indeed an important factor affecting CBI coverage, because they crucially determine health-worker satisfaction and support for a CBI [13,26]. …”

Section: Introductionmentioning

confidence: 99%

Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

Robyn

Bärnighausen

Souares

et al. 2012

BMC Health Serv Res

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BackgroundIn 2004, a community-based health insurance scheme (CBI) was introduced in Nouna health district, Burkina Faso. Since its inception, coverage has remained low and dropout rates high. One important reason for low coverage and high dropout is that health workers do not support the CBI scheme because they are dissatisfied with the provider payment mechanism of the CBI.MethodsA discrete choice experiment (DCE) was used to examine CBI provider payment attributes that influence health workers’ stated preferences for payment mechanisms. The DCE was conducted among 176 health workers employed at one of the 34 primary care facilities or the district hospital in Nouna health district. Conditional logit models with main effects and interactions terms were used for analysis.ResultsReimbursement of service fees (adjusted odds ratio (aOR) 1.49, p < 0.001) and CBI contributions for medical supplies and equipment (aOR 1.47, p < 0.001) had the strongest effect on whether the health workers chose a given provider payment mechanism. The odds of selecting a payment mechanism decreased significantly if the mechanism included (i) results-based financing (RBF) payments made through the local health management team (instead of directly to the health workers (aOR 0.86, p < 0.001)) or (ii) RBF payments based on CBI coverage achieved in the health worker’s facility relative to the coverage achieved at other facilities (instead of payments based on the numbers of individuals or households enrolled at the health worker’s facility (aOR 0.86, p < 0.001)).ConclusionsProvider payment mechanisms can crucially determine CBI performance. Based on the results from this DCE, revised CBI payment mechanisms were introduced in Nouna health district in January 2011, taking into consideration health worker preferences on how they are paid.

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“…Only two key studies in Africa have focused on knowledge and understanding of CHI by managers of health services. A study on the Maliando scheme in Guinea Conakry offered insight into perceptions of health providers at both operational and managerial levels [6], while another study looked at solidarity and financial sustainability based on an analysis of the values of CHI subscribers and promoters in Senegal [7]. …”

Section: Introductionmentioning

confidence: 99%

Community health insurance amidst abolition of user fees in Uganda: the view from policy makers and health service managers

Basaza

Criel

Stuyft

2010

BMC Health Serv Res

Self Cite

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BackgroundThis paper investigates knowledge of Community Health Insurance (CHI) and the perception of its relevance by key policy makers and health service managers in Uganda. Community Health Insurance schemes currently operate in the private-not-for-profit sector, in settings where church-based facilities function. They operate in a wider policy environment where user fees in the public sector have been abolished.MethodsSemi-structured interviews were conducted during the second half of 2007 with District Health Officers (DHOs) and senior staff of the Ministry of Health (MOH). The qualitative data collected were analyzed using the framework method, facilitated by EZ-Text software.ResultsThere is poor knowledge and understanding of CHI activities by staff of the MOH headquarters and DHOs. However, a comparison of responses reveals a relatively high level of awareness of CHI principles among DHOs compared to that of MOH staff. All the DHOs in the districts with schemes had a good understanding of CHI principles compared to DHOs in districts without schemes. Out-of-pocket expenditure remains an important feature of health care financing in Uganda despite blanket abolition of user fees in government facilities.ConclusionCHI is perceived as a relevant policy option and potential source of funds for health care. It is also considered a means of raising the quality of health care in both public and private health units. To assess whether it is also feasible to introduce CHI in the public sector, there is an urgent need to investigate the willingness and readiness of stakeholders, in particular high level political authorities, to follow this new path. The current ambiguity and contradictions in the health financing policy of the Uganda MOH need to be addressed and clarified.

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La difficulté du partenariat entre professionnels de santé et mutualistes: le cas de la mutuelle de santé Maliando en Guinée‐Conakry

Cited by 20 publications

References 8 publications

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Health worker preferences for community-based health insurance payment mechanisms: a discrete choice experiment

Community health insurance amidst abolition of user fees in Uganda: the view from policy makers and health service managers

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