Extending social protection in health through community based health organizations: evidence and challenge

This discussion paper from the International Labour Office Universitas Programme reviews available evidence on the health impact of Community Based Health Organisations (CBHOs). The authors find scarce quality data and analysis on this topic. However, they are able to draw some conclusions. They find no evidence in the published literature that CBHOs positively impact health status, particularly that of the poor. They also find that CBHOs tend to be small organisations with limited legal or “de facto” ownership by the community and significant dependence from other health subsystems or subsidies. The majority are “entry point” schemes with low market exposure and significant dependence from larger provider schemes. Accountability mechanisms within CBHOs are also limited.

Based on these findings, the authors argue that the potential of CBHOs lies in their ability to link the community with other organisational arrangements for extending social protection in health, particularly the public health sector. In this way, CBHOs may contribute towards achieving national health objectives. However, the authors stress that further research is needed to quantify the impact of CBHOs. They conclude that supporting local demands for experimentation in CBHOs, if accompanied by sound monitoring and evaluation, can contribute to identifying good performing models.