Contribution of mutual health organizations to financing, delivery, and access to health care : synthesis of research in nine West and Central African countries

This report presents case studies on the role of MHOs in the financing of, delivery of, and access to health care in nine WCA countries (Benin, Ivory Coast, Ghana, Nigeria, Mali, Senegal, South Africa, Tanzania, and Zimbabwe). Specifically, the study analyzes MHOs" actual and potential contributions in the areas of access to health care and extending social protection to disadvantaged groups, resource mobilization, health sector efficiency, quality improvement, and democratic governance. The study did not investigate the social movement dimension of the MHOs, potentially one of their major contributions to social and civic life. The study confirmed the emergence of a mutual health scheme movement in West Africa and to a lesser extent (because only one Central African country was studied) in Central Africa. These schemes are generally small- to medium-scale in terms of membership. Most are also young: about two-thirds of the 50 MHOs of those surveyed were less than 3 years old. Although MHO activities currently affect only a small fraction of the populations of the countries involved, this study shows that they have great potential and already significantly affect health care access and the social protection of disadvantaged groups by mainly targeting people in the informal and rural sectors. Another area in which the MHOs make a new -- and original -- contribution is that of democratic governance in the health sector. MHOs are able to claim popular legitimacy in representing their communities or members before the health authorities, including health care providers, to articulate the views of health care consumers on such issues as waiting times, staff behavior, and quality of services. Although MHOs" contribution to resource mobilization is currently limited, the study shows that the potential is large, given that the current contribution is constrained by factors such as low penetration of target populations (probably related to design issues that this study indicates can be remedied), low dues collection rates, and other factors. The study found that MHOs could significantly improve their own and the sector"s efficiency through a number of design features, many of which are already implemented by some WCA MHOs, such as waiting periods for new members, social control to avoid abuses, co-payments or ceilings on the amounts of coverage, and some level of obligatory membership at the family, association, or target group level (the latter feature avoids having scheme membership disproportionately composed of high-risk people). Regarding health care quality improvement, the study found that most MHOs tend to be set up around a health care provider(s) with a reputation for good quality in terms of waiting times, staff attitudes toward patients, and drug availability, but also that most, if not all, the MHOs are not well equipped to realize their full potential, especially in the more demanding areas of vetting the quality of prescriptions and other medical care provided to their members. This is partly because of their relative youth and lack of experience, partly because of their lack of managerial skills and insufficient knowledge of alternatives, and partly because of their low levels of negotiating power in relation to health care providers. Given the youth of most of the schemes, assessing their long-term sustainability on the basis of experience to date is not possible. Includes recommendations.