Time to abandon amateurism and volunteerism: addressing tensions between the Alma-Ata principle of community participation and the effectiveness of community-based health insurance in Africa

Ridde, Valéry; Antwi, Abena Asomaning; Boidin, Bruno; Chemouni, Benjamin; Hane, Fatoumata; Touré, Laurence

doi:10.1136/bmjgh-2018-001056

Cited by 38 publications

(49 citation statements)

References 32 publications

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“…Evidence elsewhere has indicated that pooling risks across members enrolled in the health insurance lessens the nancial burden on the members thereby making them more nancially resilient during illness since costs are borne by the entire pool. 25 The provider-purchaser separation means that the local governments now focus their engagement on investment in and supervision of health providers as the owners of public district and primary facilities, population-based and community-oriented public health, supervision and monitoring of health policy implementation, and advocacy on behalf of citizens. On the other hand, the regional level focuses on the management of the funds and reimbursing health care providers.…”

Section: Discussionmentioning

confidence: 99%

An Assessment of the Implementation of the Re-structured Community Health Fund in Gairo District in Tanzania

Asantemungu¹,

Maluka²

2020

Preprint

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While the government of Tanzania has been implementing community health fund (CHF) for more than two decades, the uptake of the scheme has been persistently low due to management and performance problems. As a response, from 2011 a new initiative was adopted that changed the overall structure, management and benefit packages of the CHF. This paper assesses the implementation of the newly re-structured CHF in Gairo District in Morogoro Region. This study employed a descriptive qualitative case study design using three types of data collection techniques, namely individual interviews (n=14), focus group discussions (n=4) and document review. A thematic approach was used to analyse the data. Findings show that the re-structured CHF has improved the pooling and provider payment mechanism compared to the old CHF. Benefit packages have been expanded to include referral services up to regional level. However, stakeholders, including community members, had negative perceptions of the restructured CHF owing to high annual premium rates, low incentive to enrolment officers, weak registration network and poor quality of health care services. In order to improve CHF performance and achieve universal health coverage, the central Government needs to invest more in the improvement of the quality of health care services, particularly availability of drugs and medical supplies. Additionally, the government should make CHF scheme compulsory to all members of the community who do not have alternative health insurance.

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Section: Discussionmentioning

confidence: 99%

An Assessment of the Implementation of the Re-structured Community Health Fund in Gairo District in Tanzania

Asantemungu¹,

Maluka²

2020

Preprint

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“…The role of these ideas in the construction, emergence and transfer of public policies (Béland and Cox, 2011;Kuhlmann et al, 2019) was also con rmed in this West African country's social policies (Béland and Ridde, 2016). The issue of the compulsory nature of membership of the CBHI and the state's role of stewardship of the health system had been central to the emergence of the UHC in Rwanda (Chemouni, 2018;Habiyonizeye, 2013), in contrast to in Mali or Senegal (Ridde et al, 2018). Indeed, a 2016 study conducted in Mali demonstrated that it was "the obligation that had been the decisive factor in the rejection of social insurance."…”

Section: To 1997: a Degree Of Political Willmentioning

confidence: 99%

The emergence of the national medical assistance scheme for the poorest in Mali

Touré

Ridde

2020

Global Public Health

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“…The role of these ideas in the construction, emergence and transfer of public policies [42,45] was also con rmed in this West African country's social policies [46]. The issue of the compulsory nature of membership of the CBHI and the state's role of stewardship of the health system had been central to the emergence of the UHC in Rwanda [24,47], in contrast to in Mali or Senegal [48]. Indeed, a 2016 study conducted in Mali demonstrated that it was "the obligation that had been the decisive factor in the rejection of social insurance."…”

Section: To 1997: a Degree Of Political Willmentioning

confidence: 99%

The emergence of the national medical assistance scheme for the poorest in Mali

Touré¹,

Ridde

2020

Preprint

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Background: Universal health coverage (UHC) is now high up the international agenda. There are still major needs to be met in West Africa, particularly in Mali, where providing health care for the poorest remains a big challenge. The majority of the region’s countries are currently seeking to define the content of their compulsory, contribution-based medical insurance system. However, very few countries apart from Mali have decided to, in parallel, develop a solution for poorest that is not based on contributions.Methods: This qualitative research article examines the historical process that has permitted the emergence of this ground-breaking public policy.Results: The research shows that the process has been very long, chaotic and sometimes suspended for long periods. One of the biggest challenges has been that of intersectoriality and the social construction of the groups to be targeted by this public policy (the poorest), as institutional tensions have evolved in accordance with the political issues linked to social protection. Eventually, the medical assistance scheme for the poorest (RAMED) saw the light of day in 2011, funded entirely by the government.Conclusions: Its emergence would appear to be attributable not so much to any new concern for the poorest in society but rather to a desire to give the social protection policy engaged in a guarantee of universality. The RAMED nonetheless remains an innovation within French-speaking West Africa.

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Time to abandon amateurism and volunteerism: addressing tensions between the Alma-Ata principle of community participation and the effectiveness of community-based health insurance in Africa

Cited by 38 publications

References 32 publications

An Assessment of the Implementation of the Re-structured Community Health Fund in Gairo District in Tanzania

An Assessment of the Implementation of the Re-structured Community Health Fund in Gairo District in Tanzania

The emergence of the national medical assistance scheme for the poorest in Mali

The emergence of the national medical assistance scheme for the poorest in Mali

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