The Role of Cooperatives and Mutual Health Organizations in the Extension of Nondiscriminatory Universal Health Insurance in Africa

In most African countries, there is no universal health insurance. More aggravatingly, the national funds for social insurance, open only to formal sector workers, do not support the risk of disease. Therefore, people do not have access to quality healthcare, given the high prices practiced in health centers. Rich people can afford the prices for private insurance schemes, but the poor (more numerous) are left to themselves with no insurance. Therefore, the predominant system discriminates against the relatively poor, who are already statistically more likely to face serious health issues. Yet every human being has the right to health, as recalled by the Universal Declaration of Human Rights (Article 25) or the International Covenant on Economic, Social and Cultural Rights (Article 12). That is a reason why in recent years, programs for the promotion of mutual health organizations (MHOs) have been developed on the continent as an alternative for access to healthcare for all. Mutual societies are autonomous associations of people who want to organize their own healthcare by means of contributions and through a contract with a health center. It is therefore a service organized by private actors to provide social services (microinsurance), following a solidarity approach. In 2014, a study was conducted on the state of MHOs, and it was found that their penetration rate does not exceed 2% in most countries, even though they are accessible to all. Various reasons may explain this weakness. The main reasons include the nonrespect of healthcare agreements in health centers (usually public hospitals) as well as the difficulty of collecting contributions due to irregular incomes of members of MHOs, usually informal sector actors. On the first point, it was proposed to associate health cooperative clinics (HCC) with MHOs. The clinics are the property of the MHO, and the problem of agreement may find a solution. Moreover, the cooperative and the mutual society share the same operating principles as social and solidarity economy organizations. On the second point, it was advised to make contracts with organized groups, in particular agricultural cooperatives, in order to facilitate the collection of contributions with the help of savings and credit cooperatives. These experiments are currently underway in various African countries, and we intend to focus on Cameroon. The ambition is to raise public awareness of the possibility of laying the groundwork for public universal health insurance based on the experience of cooperatives and MHOs. The purpose of this reflection is to examine the conditions to be fulfilled in order for cooperatives and mutual societies to play a leading role in the access to quality healthcare insurance, as well as the promotion of the right to healthcare for all, thus alleviating the issues associated with health coverage discrimination. Thus, in assessing the consequences of the absence of mandatory health insurance, the prospect is to see to what extent such insurance can emerge in African countries, especially in Cameroon, following the experience of European countries, particularly Belgium, where this mandatory health insurance is carried by MHOs.