Health Insurance for the Poor? Determinants of Participation in Community-based Health Insurance Schemes in Rural Senegal

This paper deals with the subject of participation in local development organizations and institutions.

The paper:

• Accepts that community-based initiatives have an important role to play in improving poor peoples risk-sharing arrangements;
• Examines whether these new emerging institutions are able to address the problem of social exclusion in local communities;
• Uses household data from a rural area in Senegal to show that:
  • Community-based health insurance schemes address important needs of the poor by attracting those people who would be otherwise deprived of access to quality health care;
  • However, the poorest of the poor remain largely excluded because they do not have the resources to pay the insurance premium;
  • Other socioeconomic characteristics determine participation rates;
  • Local initiatives might reduce the problem of social exclusion of a certain group of the population.

The author states that the findings of the case study lead to the conclusion that:

• Social services provided by local institutions and organizations can be a first, but incomplete, step to better social protection of the poor;
• The major challenge for governments and donors is to find appropriate ways and instruments to promote these initiatives by making use of their local specifications as well as by addressing their deficiencies;
• Possible avenues which could address these weaknesses are:
  • Well-targeted subsidies for the poorest;
  • Strengthening of the management capacity;
  • Training and linking to more formalized public systems.