Community-Based Health Insurance (CBHI) has been a strategy that has been widely used in many African countries and it is growing in popularity. However, many of these schemes have only existed as pilots with variable degree of success that have not been scaled up. What is your comment on this
Community – Based Health Insurance (CBHI) is a form of pre-payment healthcare financing mechanism that assists communities to contribute on a regular basis so that members do not need to have cash on hand at the time when they need healthcare. Community here is broadly defined to include a cohesive group of households or individuals associated in a neighbourhood, village community, commercial, workplace or other occupational setting.
Many programmes have in built flexibility, in that the members determine the benefit package and the choice of providers. The members also make the decision on the amount of premium to be paid and whether this should be paid once monthly or in installments. An elected board of trustees from among the members administers the fund itself. It has been noted that this approach is likely be successful in settings where the community, neighbourhood or informal workplace setting is already organized for other purposes, such as community-based credit.
Nonetheless, CBHI has certain drawbacks. Incomes in most rural areas and in the urban informal sector are very uncertain. These schemes cover only a small portion of communities and have small risk pools, which affect their sustainability. CBHI require management capacity which does not exist in many cases. And they tend to exclude the poorest unless contributions of the poor are heavily subsidized. There has also been too little attention paid to these schemes by both national governments and development agencies.
All these problems not withstanding some good lessons have been learnt and there is now a big push for scaling up this strategy by modifying some of the operational procedures. First, payments of premiums have to be undertaken in a stress free manner, such as by tying them to income cycles. Secondly, there should be emphasis on large-scale interventions that can reach a significant proportion of the poor. The focus here should be overall population coverable by a multiple of schemes looking at those same issues as those of more sophisticated social and private health insurance schemes – building up adequate reserves, health plans being informed purchasers, consumer education, re-insurance etc. And finally, more of government and donor funds should be allocated to work on the demand side rather than on the supply side as it has been done traditionally.