Mutuality, cultural diversity and development

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Mutuality, cultural diversity and development

• Health and microinsurance in West Africa

Kulmie Samantar, FNMF
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Background

• intermediate and low income countries
• rather public or quite largely private health
  care access,
• various experiences of health financing and
  development,
• very disparate socio-sanitary environments and
  situations

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Background (continued)

• Formal (or modern) sector includes private sector
  wage-earners and civil servants.
• It roughly represents 10 to 30 of the
  population.
• The existing informal sector is urban and
  peri-urban, well developed, sometimes very active
  and generating employment (characterized by
  precarity and volatility).
• The types of health risk management of these
  populations may range from conventional legal
  systems to sometimes nothing.

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Health risk is not or hardly managed by these
organisations..

• Social security systems in the CIPRES region (14
  West and Central African countries) are
  characterized by the management of the following
  risks
• old age,
• family allowances (maternity)
• industrial accidents

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Can mutual insurance companies bring answers?

• Stakes
• cost recovery organisation
• health care provision organisation
• getting towards a global social protection system
  
• population participation

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For public authorities, a range of systems

• solidarity national and/or local?
• relations with professionals contractual or
  market relations?
• health priorities hospital and primary health
  care how to have them cohabitate within coherent
  and participative national politics?
• resources and access to health care for paying
  users or any participant?

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Mutual insurance company development economic
stakes and/or political system?

• health education
• responsibilisation of management
• involving users in decisions
• stakes in terms of proximity!

• lessening the gap between formal/informal sector
• GDP and health expenditure per inhabitant
• counterbalance to parallel financing and
  corruption

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Health costs in the GDP?

• In a great number of the countries concerned, the
  share of private financing in health costs is
  superior to the public financing one. These costs
  rarely exceed 4 of the GDP, and represent an
  average USD 15 to 25.
• Cause withdrawal of State financing of health
  care access.
• Consequence the health sector is structurally
  underfinanced.

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Conditions for mutual insurance company
development

• a clear juridical status defining room for
  manoeuvre (get out of marginality and strictly
  isolated action)
• economic and prudential regulations offering
  guarantee on funds use
• a good articulation with the other health system
  structures
• a good articulation with the credit union
  structures and the traditional banking sector

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Development asset of mutual insurance companies
being part of democratic process.

• Mutuality can play a part in working out a social
  contract and good social governance (to create
  the confidence necessary for developing
  mutuality).
• Mutual insurance companies need a clear
  institutional framework and to be recognized as
  partners by public authorities,
• But basically, mutual insurance companies build
  upon total free expression of choices by members,
  citizens and health system users.

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Consequences of mutual insurance company
development

• All of these conditions (juridical framework,
  democracy, economic and contractual regulations)
  also contribute to
• national health politics,
• solidarity organisation,
• synergy of public investments between health
  (primary health care and hospitalization) and
  development of infrastructures (road network,
  telecoms, vocational training, etc.)

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Then the question about mutual insurance
companies will find its answer

• a method of organizing primary health care?
  Within the framework of poverty alleviation
  programs and in an access to work perspective.
• financial partners involved in economic
  development programs (HIPCs) In the case of the
  Initiative for the HIPCs, it will be possible to
  make some amounts available to encourage
  investment in a context of work development
  through amelioration of health status or
  microinsurance financial partners?
• a step in building global health system and
  cover? The 89th session of the International
  Labour Conference (ILO) acknowledged they could
  represent the first steps.