Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal

Thomas Rouyard, Yukichi Mano, Bocar Mamadou Daff, Serigne Diouf, Khadidiatou Fall Dia, Laetitia Duval, Josselin Thuilliez and Ryota Nakamura
Additional contact information
Thomas Rouyard: HIAS Health - Research Center for Health Policy and Economics, Hitotsubashi University [Tokyo]
Bocar Mamadou Daff: UHC Senegal - National Agency for Universal Health Financial Protection, Dakar, Senegal
Serigne Diouf: UHC Senegal - National Agency for Universal Health Financial Protection, Dakar, Senegal
Khadidiatou Fall Dia: UHC Senegal - National Agency for Universal Health Financial Protection, Dakar, Senegal
Ryota Nakamura: HIAS Health - Research Center for Health Policy and Economics, Hitotsubashi University [Tokyo]

Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) from HAL

Abstract: Community-based health insurance (CBHI) has been implemented in many low and middle-income countries to increase financial risk protection in populations without access to formal health insurance. While the design of such social programs is fundamental to ensuring equitable access to care, little is known about the operational and structural factors influencing enrolment in CBHI schemes. In this study, we took advantage of newly established data monitoring requirements in Senegal to explore the association between the operational capacity and structure of CBHI schemes—also termed ‘mutual health organisations' (MHO) in francophone countries—and their enrolment levels. The dataset comprised 12 waves of quarterly data over 2017–2019 and covered all 676 MHOs registered in the country. Primary analyses were conducted using dynamic panel data regression analysis. We found that higher operational capacity significantly predicted higher performance: enrolment was positively associated with the presence of a salaried manager at the MHO level (12% more total enrollees, 23% more poor members) and with stronger cooperation between MHOs and local health posts (for each additional contract signed, total enrollees and poor members increased by 7% and 5%, respectively). However, higher operational capacity was only modestly associated with higher sustainability proxied by the proportion of enrollees up to date with premium payment. We also found that structural factors were influential, with MHOs located within a health facility enrolling fewer poor members (−16%). Sensitivity analyses showed that these associations were robust. Our findings suggest that policies aimed at professionalising and reinforcing the operational capacity of MHOs could accelerate the expansion of CBHI coverage, including in the most impoverished populations. However, they also suggest that increasing operational capacity alone may be insufficient to make CBHI schemes sustainable over time.

Keywords: Universal health coverage; community-based health insurance; mutual health organisation; sub-Saharan Africa; Senegal (search for similar items in EconPapers)
Date: 2022-08
Note: View the original document on HAL open archive server: https://shs.hal.science/halshs-03641124
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Published in Health Policy and Planning, 2022, 37 (7), pp.858-871. ⟨10.1093/heapol/czac033⟩

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Working Paper: Operational and Structural Factors Influencing Enrolment in Community-Based Health Insurance Schemes: An Observational Study Using 12 Waves of Nationwide Panel Data from Senegal (2022)
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Persistent link: https://EconPapers.repec.org/RePEc:hal:cesptp:halshs-03641124

DOI: 10.1093/heapol/czac033

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