Community-Based Health Insurance: Experiences and Lessons Learned from East Africa

This document presents the report of a study on community-based health insurance (CBHI) schemes targeted at improving the health care financing mechanisms, especially for rural populations in East Africa. It chronicles and compares the experiences of schemes in Kenya, Tanzania, Uganda, and other countries, providing a resource to schemes, policymakers and community members as it examines health care financing options and opportunities. Specifically, it:

• Documents progress and achievement;
• Identifies problematic areas and documents solutions used to address them;
• Identifies ways of improving health care financing models;
• Provides both general and scheme-specific information which can be used for monitoring and improving CBHI schemes;
• And provides information that can be used to design technical assistance strategies and programs.

It argues that the CBHI operations have achieved limited successes in designing and implementing affordable, participatory, and sustainable health care financing mechanisms for populations with limited resources but great need for health services. It draws from the following schemes carried out by the Partnerships for Health Reform (PHR), a USAID-funded project: Community Health Fund (Tanzania); Chogoria Hospital Insurance Scheme (Kenya); Kisiizi Hospital Health Society (Uganda); Ishaka Hospital Health Plan (Uganda); Atiman Insurance Scheme (Tanzania) and Mburahati Health Trust Fund (Tanzania) and concludes that:

• Community participation is important to the success of a community-based health insurance scheme;
• Failure in risk management is one of the greatest threats to the viability of the CBHI schemes;
• Provider staff require training in order to appreciate the need for the scheme so that they may handle the client/patient with the respect they deserve;
• Marketing to the community by the scheme is very important to ensure membership levels expand during start-up and are kept high;
• Underwriting of the initial losses by the government can help the scheme set low rates at the beginning but may also give a false sense of affordability to the potential clients;
• It is important to set realistic premiums at the beginning of the scheme and to periodically review and adjust them;
• Schemes need to adopt a business culture in their management styles.

Hence the schemes can be sustainable in the long term only if serious attention is paid to their design and management.