Community-Based Health Insurance Schemes in Africa: Which Factors Really Induce Membership ?

Health micro-insurance systems have experienced a fast development for some fifteen years in sub-Saharan Africa as a means of improving the access of the poor to healthcare services. The present article focuses mainly on community-based health insurance (CBHI) systems, as they currently constitute one of the most developed forms of health micro-insurance.
However, it must be acknowledged that the enrolment rates remain particularly weak and coverage of the target population only rarely reaches 10%. Several authors have already observed this fact and undertaken research on the factors which influence enrolment. Nevertheless, the methodologies used, size of the samples, characteristics of the surveyed individuals, inclusion or not of non-members in the surveys, geographical areas etc. vary a lot from one author to the other. This is why this article aims at synthesizing the empirical studies carried out to date and to identify major concurring results beyond methodological differences. We finally come out with two factors which seem to play a major role and six others which seem to have a significant influence on enrolment, while surveys do not confirm the role of various other variables.
We conclude with some lessons regarding the roles of the promoters and supporting NGOs in the establishment of CBHI schemes.