Results of the inventory and cpinion survey are summarized briefly below. Some of the othei proposals suggested by the Commission are mentioned later in this report.: In 1989, the Commission attempted to conduct an inventory of all mutual associations in Zaire. Difficulties in communication linmited the focus to about 1,000 associations in t1-e Kinshasa area, however. A total of 562 associations (mostly informal) completed the survey form. Some associations were contacted directly; others were identified through government administrative channels and by announcements on public radio.

The survey defined a mutual association very loosely. All types of formal and informal groups were targeted, including cultural groups, agricultural and handicraft cooperatives, health zones, and savings organizations.

The inventory found that most informal associations were small (less than 50 members) and require a monthly contribution of between 100 to 500 Z in order to finance certain benefits. About 30% of the associations surveyed provided financial assistance in case of illness. Finan..al assistance was also provided for events such as a death in the family, marriage, birth, or other fintancial problems. The GOZ findings about informal associations were similar to the findings of the World Bank team research, discussed in Section I.

The inventory a!so described ten, more formal assoc.ations (numbers I through 10) which offer or a-e planning to offer some form of health insurance. In the course of the present study, two additional systems were identified (number 11 and 12). All 12 systems are described in Section II.

1. Bwamanda Health Zone, Equateur Region 2. Bokoro Hlealth Zone, Bandundu Region

3. St. Alphonse Health Center, Kinshasa 4. Caisse de Solidarite Ouvriere et Paysanne (CASOP), Kinshasa 5. Reseau Medecins de Familles (REMEF), Kinshasa 6. Masisi Health Zone, Kivu Region 7. Mutuelle 'Union et Prtvoyance' (UPM), Kinshasa 8. Mutualite de Solidarite Chretienne, Kinshasa 9. MUZAS, Kinshasa 10. LETISSA, Kinshasa

- I. Sona Bata Health Zone

12. SNHR Employee Cooperative in Rutshuru.

The public opinion survey, also in 1989, interviewed 850 individuals in Kinshasa from different socio-economic levels and professional groups to learn about the Prevalence of membership in mutual associations and perceived advantages and disadvantages to membership.

Sixty-three percent of respondents were members of some sort of mutual association (not necessarily related to health). About half of current members responded that they were satisfied with how the association operated. For those who were dissatisfied, the key reasons were financial: either a lack of sufficient financial resources, or irregularity of contributions by members. The survey also detailed reasons why people join mutual associations, and what role members saw for the State. On the latter question, most respondents saw the State's role as one of 'encadremento rather than supervision or management.

I This report does not attenpt to analyze the legal changes proposed in the Commission report. While legal issues will become very important as the insurance industry develops, they were not considered of primary interest for the initial evaluation of existing systems.

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