Scaling up community-based health insurance in Mali

This briefing paper examines the process of scaling up a community-based health insurance (CBHI) programme in Mali to make it a formal national straegy for CBHI, and examines the success factors in CBHI strategy development.

For more than 20 years, CBHI has been a component of the health financing system in Mali. Known as mutual health organisations, or mutuelles in French, CBHI schemes are not-for-profit mechanisms of health financing grounded in principles of solidarity and risk sharing. The Government of Mali uses mutuelles to address limited access to and low utilisation of priority health services. Although the legal framework was adopted by the Government in 1996 to support mutuelles, it was only in 2010-2011 that a national strategy for CBHI was developed and formally adopted.

The document concludes that the adoption of a national CBHI strategy in Mali provides a tremendous opportunity to help address financial barriers for Malians to access and use priority health services, especially in the informal and agricultural sectors, through a phased scale-up for expanded health coverage. The initial phase of the CBHI roll-out will allow time to make adjustments and determine the most efficient institutional arrangements for further scale-up. Based on the monitoring and measurement of CBHI implementation during the first phase, if modifications are required before full national scale-up, then improvements will be integrated into the national strategy before the second phase of the roll-out. Critical components of the first phase currently under development include a communication strategy, implementation plans for each mutuelle and district network as well as the establishment and implementation of a monitoring and evaluation plan. Although there is no one path to achieving universal health coverage, over a decade of experience with CBHI in Mali has shown that CBHI has the potential to act as a platform for catalysing progress towards universal health coverage.