Kliniken &… Institute Heidelberger Institut… Groups & Projects Working Groups Research Health Results-Based… CBI

Community-based Health Insurance (CBI)

Investigators: Devendra Prasad Gwanali, Aurélia Souares, Manuela de Allegri, Rainer Sauerborn

Collaborative partner: Dr Ali Sié, Mamadou Sanon (Nouna Health Research Centre, Burkina Faso), Dr Millogo (District sanitaire de Nouna), Ghislain Tiawara (Assurance Maladie à Base Communautaire, Nouna)

Community-based health insurance (CBI) schemes have been emerging in middle and low-income countries.  It is believed that CBI has potential to lower the financial barrier for improved access to health care and thereby contribute to better health outcomes.  Most of the schemes report a low enrollment and problem with cost recovery and also there is a lack of scientific evidence on the impact of CBI on health care utilization, on health status, on household economics and on quality of care.     

D2 Project under the Research Grant SFB 544 of German Research Society (DFG) has been trying to provide the scientific evidence to design and implementation of such community-based scheme in Nouna Health District, Burkina Faso in Collaboration with Nouna Health Research Center (CRSN).

In first phase, it laid the scientific basis for introducing community-based health insurance by exploring risk perceptions and traditional risk-sharing arrangements, examined community preference to benefit package and analyzed its costs and willingness to pay for benefit package. In second phase, it carried out further studies to build up the evidence for a rational design of CBI policy. On the basis of this scientific evidence, the first enrolment campaign of CBI was started in February 2004 in the first cluster (11 villages) in the DSS area of Nouna.

The third phase, ongoing phase, is the impact evaluation phase. It is working with following objectives:

  1. To understand the factors influencing households’ enrolment in CBI
  2. To measure the impact of CBI by analyzing difference between enrolled and non-enrolled households with regard to:
    1. Health Care Utilization
    2. Health outcomes
    3. Household poverty
    4. Quality of care