The project’s goal is to test in a region of Mali the implementation of universal health insurance, including coverage for populations employed in the agricultural and informal sectors. Social security policy in Mali opted for the implementation of three mechanisms for guaranteeing the financing of health coverage for the people of Mali:a mandatory insurance scheme for State civil servants and private sector employees; a mutual scheme for informal sector and agricultural workers, and a medical assistance scheme for the poor.Although the mandatory insurance and medical assistance schemes are in the final stages, the National Mutual Expansion Strategy (SNEM), the goal of which is to provide the great majority of the population with coverage, is still in the development phase.The SNEM plans for the creation of mutuals at the local, district and regional levels that will be in charge of health insurance administration and follow-up (promotion, membership, premium collection, claims processing, health facility monitoring, etc.) Proceeds will cover primary health care (at public health centers) as well as hospitalizations (in district and regional public hospitals). The cost of the corresponding insurance premiums will be shared by the State and the beneficiary families, each paying 50%.
As a pilot phase prior to implementation of the SNEM nationally, the UTM, SOCODEVI and MACIF have launched Kénéya Sabatili (PKS), in the Sikasso region. The purpose of the pilot project is to test the mechanisms to be set up to ensure the efficient functioning of the partnership between mutual organizations and the State (in particular the grant payment set-up and information follow-up), as well as strengthening the means for promoting products traditionally proposed by mutual health organizations.
The project will proceed in stages:
Among the main challenges expected in the project are:
Implementation of the 50% co-financing of premiums promised by the State has been considerably delayed, jeopardizing the financial stability of the project;
The receptivity on the part of existing mutual organizations with regard to restructuring has been lukewarm and remains insufficient.
The region’s precarious socioeconomic situation limits the populations payment capacity;risk ofdeclining agricultural prices, drought, poor harvests, chronic indebtedness;
The restructuring process is lagging, for too many players are involved.
The Cooperative Society for International Development(SOCODEVI), an international NGO based in Canada, supports the projects of mutual, cooperative or associative institutions or movements, and contributes to the sustainable development of the countries in which it is involved with a view to empowering their inhabitants.SOCODEVI, in partnership with MACIF, has been present in Sikasso since 2007 where they have created and supported an MHO that at present provides coverage to 2,300 beneficiaries.
MACIFis a French mutual insurance company that celebrated its 50 years of existence in 2010 together with its 4.8 million members.Today it is the number-one provider of homeowner, automobile and motorcycle insurance in France.MACIF is involved in micro-insurance projects in India, Senegal and Mali, in collaboration with NGOs and international development organizations.
The project will be implemented in the Sikasso region of southern Mali, beginning with the district of Sikasso and then the district of Koutiala, representing a total population of 638,440.The goal is to provide better access to health care for 25,000 persons within three years.The population of these areas is 75% rural (employed mainly in cotton production) and nearly 90% of them are illiterate.The average annual income is less than USD 160.The population is young (55% are under 15).With regard to health care, the public health facility attendance rate is a mere 0.4 contacts/year/person and 60% of health expenditures are paid out-of-pocket by the population, which underscores the substantial financial barrier to access to care.
What are the determinants of the demand for health insurance?What is the impact of co-financing by the State of insurance premiums on demand?
What is the impact of the communication strategies in place?
How can an effective public-private partnership be set up?
What capacity strengthening strategies need to be introduced to ensure efficient, professional administration of mutual organizations in local communities and the local Union of Mutual Organizations?
It is important that the government become involved in publicizing the project backed by the public-private partnership.¨
Calculating the insurance premium amount is the first key step in defining ways of implementing “universal” health coverage.
The homogenization of health insurance coverage for the population of Sikasso seems to strengthen the confidence of the various players in the mutualist movement.
The Union Technique de la Mutualité Malienne(UTM), created in April 1998, is the apex organization of mutual health organizations (MHOs) in Mali.It is present in seven of Mali’s eight regions and supports 80 mutual health organizations both in rural areas, where it provides technical assistance to MHOs in villages, and in urban areas where, since 2000, it has administered a health product called Voluntary Mutual Health Insurance (or VMHI; in French, Assurance mutuelle volontaire or AMV). This product covers primary and secondary health care in public health facilities.If is offered to the populations of the country's nine main towns (60,000 beneficiaries in 2010). The UTM is regularly invited by the government and donors to contribute to the reflection process concerning the implementation of health insurance schemes on a national level.
