Assessment of the Viability of Community-Based Health Insurance Schemes in the Ziguinchor Department from 2016 to 2018 in the Context of Universal Health Coverage (Senegal)
Authors: Tacko Diop , Mouhamed Fall , Mareme Sougou , Selly Ly , Boubacar Gueye , Coly Bop , Ousseynou Ka , Mbacke Leye 
Published: October 2024

&lt;i&gt;Introduction&lt;/i&gt;: This study examines the viability of community-based health insurance schemes in the Ziguinchor department of Senegal from 2016 to 2018, within the context of universal health coverage. Health insurance schemes have emerged as a promising solution to extend social health protection to informal sector workers and rural populations. However, despite political support, these structures face persistent challenges in terms of enrollment, member retention, and management. The study aims to assess the viability of these schemes, as well as the perceptions of various stakeholders on mutual health insurance. &lt;i&gt;Methodology&lt;/i&gt;: The study adopted a mixed approach, combining quantitative and qualitative methods, based on the theoretical framework developed with the support of the International Labor Office (ILO). This framework evaluates the viability of health insurance schemes according to four dimensions: institutional, technical, functional, and financial/economic. A questionnaire with 87 questions was used to collect quantitative data on these aspects from the seven health insurance schemes in the Ziguinchor department. For the qualitative component, focus groups and individual interviews were conducted with various actors, including beneficiaries, non-beneficiaries, community leaders, scheme managers, and healthcare providers. &lt;i&gt;Results&lt;/i&gt;: The study&apos;s findings reveal a complex situation for the health insurance schemes in the Ziguinchor department. Institutionally, the schemes have a solid foundation with legal status, internal regulations, and affiliation to a departmental union. Technically, membership is voluntary and family-based, with control mechanisms in place, although their effectiveness is limited. Functional viability shows positive signs with a membership growth rate of 20.18%, but the overall penetration rate remains low at 16.99%, and the premium collection rate is very low, averaging 26.78%. The financial situation is particularly of concern: no scheme can meet its short or long-term debts, and the average claims ratio is excessively high at 282%. As for stakeholder perceptions, they are mixed: while the schemes are generally considered beneficial, significant practical difficulties are identified, including lack of information, funding problems, and procedural complexity. &lt;i&gt;Conclusion&lt;/i&gt;: The study highlights the complexity of the role of health insurance schemes in the quest for universal health coverage. Despite undeniable strengths, the schemes face considerable challenges in terms of functional and financial viability. Corrective measures are necessary, including strengthening management capacities, innovating premium collection methods, and improving communication. An evolution of the model is also suggested, potentially towards greater integration into a national social protection system or the development of innovative public-private partnerships.