Assessment of the Feasibility of Community-based Health Insurance (CBHI) Scheme for Financial Risk Protection in Three African Countries: A Systematic Review

Abstract

Of all the risks facing poor households, health risks pose the greatest threat to their lives and livelihoods. One of the ways that poor communities manage health risks, in combination with publicly financed health care services, is community-based health
insurance scheme (CBHI). Health care financing through CBHI is a growing concept in the sub-Saharan Africa, and this study has the objective of assessing the effectiveness of three of these schemes to see if they improved access to health care and reduced
financial burden for their members in the case of illness and if they stabilized members incomes and helped to preserve assets when they fall sick. Three empirical studies were selected from the countries of Senegal, Rwanda and Nigeria to examine how they have fared in fulfilling the above objectives. The results of the review were mixed. Results seem to confirm the researchers’ hypothesis that community-financing through pre-payment and risk-sharing reduces financial barriers to health care. The ‘‘upper
income’’ strata tend to participate more than the average group, for inability to afford the required insurance premium. Limited coverage offered by the schemes constitute a threat of catastrophic illness, which is enough to drive individuals and families into
poverty.