Community-based health financing schemes

There is increasing interest in the role of community-based health financing schemes in improving equity and access of the poor to essential health care. These schemes provide a mechanism for community-level pooling of risk in relation to sickness, and sometimes grow out of traditional risk-sharing schemes, such as burial societies in Africa.

An overview of community-based health financing outlines how these schemes are set up, how they operate and their strengths and limitations. Paying in potatoes: community-based health insurance for the rural and informal sector looks at the strengths of community-based insurance schemes that have been set up in Bolivia, Bangladesh and the Democratic Republic of Congo in response to user charges.

Pre-requisites for these schemes to work include: presence of an external organisation with the capacity to design, manage, implement and sustain the scheme; strong community trust in the implementing organisation; availability of local health providers capable of providing essential health services to a basic standard.

These schemes are usually only implemented on a small-scale, and cover relatively limited geographical areas. Existing evidence suggests that the very poor are often excluded, although BRAC has had some success with targeting the very poor in its CFPR/TUP programme. Most schemes manage at covering the small-scale costs associated with accessing primary services, but fail in covering catastrophic medical expenditure associated with hospitalisation.