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Impact of community-based health insu-
rance and other financing mechanisms on
quality of care in Sub-Saharan Africa
Project team:
Aurélia Souares, Jake Robyn,
Rainer Sauerborn
External Collaboration:
Ali Sié, Germain
Savadogo, Centre de Recherche en Santé de
Nouna, Burkina Faso
Community-based health insurance (CBI),
one form of community financing, has been
seen as an attractive solution to the challen-
ge of generating financial resources for the
formal health sector in low- and middle-in-
come countries. In particular, they are seen
as a potential instrument to improve access
to health care by reducing financial barriers
to health services, empowering enrollees,
and improving the quality of care provided.
In recent years, the development of CBI pro-
grams in Sub-Saharan Africa has garnered
substantial interest by both researchers
and policymakers alike. In early 2004, a CBI
scheme (Assurance Maladie à Base Commu-
nautaire - AMBC) was introduced in Nouna
district, Burkina Faso. As the perception of
quality is a major factor for the predicted
retention of patients in modern health care
systems and also seems to be an important
factor of enrolment and retention of those
enrolled in health insurance, the different
factors related to patients’ perception of
quality of care are an important problem to
be tackled. We used observation, in-depth
interview and exit questionnaire to assess
potential differences, between CBI enrollees
and the general population not enrolled in
the scheme, in the objective and perceived
quality of care of primary health care facili-
ties contracted with the Nouna CBI scheme.
Health care financing reforms should en-
hance a more equitable access to care (free
health care, health insurance) and improve
performances in health service delivery
(performance-based funding). But their inte-
gration into national health systems might
be a challenge for the system’s stability,
health care quality and the sustainability of
targeted health programs.
Research project developed are aiming at
analyzing this impact on quality of health
care.
Salzburg global seminar
Michael Marx and Sylvia Sax joined Dr.
Rashad Massoud and other quality experts
in the planning committee for a global
seminar held at the Schloss Leopoldskron
in Salzburg, Austria from April 22 - 27, 2012.
The seminar focused on health care impro-
vement in low- and middle-income coun-
tries and the target group was high level
policy makers and practitioners from these
countries. The aim of the seminar was to
examine global accomplishments and failu-
res in quality improvement, their reasons
and challenges of taking successful efforts
forward in our increasingly complex health
systems over the next five to ten years. A
framework paper has been submitted to the
British Medical Journal.
Other quality management
activities at evaplan
:
›› 2010-2011 capacity building for effec-
tive health project: evaplan and AOK
Consult jointly implement a one year
blended learning course on QM for
senior health professionals from Kenya,
Tanzania, Cambodia, Vietnam on behalf
for GIZ (formerly InWEnt).
›› 2010 evaplan implemented a regional
symposium entitled "Measuring and
improving quality in maternal health
care: chances and challenges for cen-
tral Asia" (Uzbekistan, Tajikistan and
Kyrgyzstan) on behalf of GIZ.
›› Expanded quality management using
information power (EQUIP) research
project funded by the EU 7th framework
programme to improve maternal and
new-born health in Tanzania and Ugan-
da: evaplan is responsible for the work
package on Quality Management
www.equip-project.eu
›› 2009 evaplan and the AQUA Institute
in Göttingen undertook a consultancy
to strengthen the process of accredita-
tion in the health sector in Kenya.
›› QM-consultancies (including con-
ceptual work, implementation and
training courses) conducted on behalf
of GIZ in India, Bangladesh, Pakistan
and Yemen.