Improving Access to Health Care in Cameroon by Supporting Mutual Health Organizations
February 5, 2008
"The MHO saved our daughter's life" — Baba Maina, father of a beneficiary
The health sector in the central West African republic of Cameroon is being transformed through multidimensional support from the USAID-funded Action for West Africa Region-Reproductive Health (AWARE-RH) project. This five-year cooperative agreement, designed to reinforce regional institutions and capacity to address reproductive health and child survival, is managed by EngenderHealth, working in partnership with Abt Associates, Academy for Educational Development (AED), and Management Services for Health (MSH).
Abt Associates is leading one of four strategic objectives for AWARE-RH — the development and dissemination of health sector reform models region-wide. Focus areas include community-based health financing, National Health Accounts (NHA), and reproductive health commodity security. Among the key "best practices" Abt Associates is promoting regionally are community-based health insurance schemes known as mutual health organizations (MHOs).
Women celebrate at the launch of an MHO in Bafoussam, Cameroon (click image for a larger version)
MHOs are not-for-profit, voluntary, community-based schemes to which the member individuals or households make regular payments that finance all or part of their basic health care services when they become ill. Members help manage the plans and determine which health services will be covered, and then negotiate the care package with public or private health providers. MHOs help those most in need of financial assistance for health care — rural populations and informal sector workers excluded from formal health insurance (which typically covers only a small minority, primarily those working directly for governments or large corporations). MHOs have been shown to increase access to health services among children and pregnant women in several African countries.
Cameroon, known as "Africa in miniature" because of its geological and cultural diversity, is in particular need of MHOs because most Cameroonians live in poverty as subsistence farmers and have very limited physical and financial access to health care. Until recently, Cameroon had very few MHOs, but with the support of AWARE-RH this situation is now changing.
In 2004, in collaboration with La Concertation (a regional network of MHOs), AWARE-RH conducted a forum in Bamako, Mali to present best and promising MHO practices to participants from 25 countries in West and Central Africa. After the forum, a non-governmental organization from Cameroon called Service of Support to Local Initiatives of Development (SAILD) expressed a keen interest in integrating a health financing component into its existing community saving schemes. SAILD supports 47 micro-finance (credit and savings) organizations in Cameroon and linking MHOs to such well-established savings associations makes an excellent partnership. Communities feel a sense of ownership and trust in these micro-finance organizations because they are often owned and managed by community members and they are organized on the same principles and institutional understanding as MHOs, increasing the likelihood that community members will trust the MHOs and join them.
There are other benefits too. Integrating health financing into micro-finance organizations is a unique way to bring health care financing to many communities and can be beneficial to both organizations. Money contributed to the MHO can be invested in the credit-saving schemes, strengthening them and increasing their capacity for giving out loans. Given that they will be managed together, the MHO can benefit from the knowledge and experience of the savings association. Insurance premiums can be deducted directly from member's savings accounts, thereby increasing the efficiency of insurance premium collection — often a real problem for MHOs. Members may even take a loan from the savings association to pay their insurance premiums in full for a whole year, which is cheaper than paying in monthly installments. And providing health insurance coverage for members of the credit-saving schemes minimizes the risk of loan default as a result of unpredictable health care expenditures.
AWARE-RH helped SAILD conduct social, economic, technical, and institutional feasibility studies in three selected districts in the Western Province of Cameroon — Bangoua, Baméka, and Galim. Information was collected on a number of factors crucial to the success of the mutual health organizations including data on the social organization in targeted districts, the sources of income and their distribution, information on health care centers, estimated costs of the health service package, the value of the premium and the membership fee, and the relationship between the micro-finance organizations and the MHOs. The feasibility studies concluded that establishing MHOs in the three chosen districts was financially viable.
Awareness campaigns were then organized to help these communities appreciate the importance of investing in their health, to make each aware that their mutual health organization collectively belongs to them, and that its success depends on their membership. The Bangoua, Baméka, and Galim MHOs were launched in 2005 with members paying a premium ranging from 360 FCFA ($0.66) to 480 FCFA ($0.88) per person per month. This covers 70 to 100 percent of the cost of certain services, including medical consultations, surgeries, delivery and ante- and postnatal care.
When covering the many successes of AWARE-RH a Cameroonian newspaper, the Farmer's Voice, published several testimonies to illustrate the often profound impact MHO membership can have on beneficiaries. Hadja Aissatou for example told how she used to treat her Malaria with Aspirin and Paracetamol bought on the streets from "doubtful sources," expressing her relief at the low cost of the treatment she obtained through her MHO, and proclaiming that "I will never risk my life again with street drugs." And Baba Maina recounted "with great joy" how his daughter's life had been saved because of his MHO membership — she had fallen seriously ill when no money was available to pay hospital bills because his crops were not yet harvested. The experience has transformed Baba's life and he is now actively involved in encouraging others to join the MHO.
The Ministry of Health in Cameroon has set itself the objective of developing MHOs to cover 40 percent of the population and plans to achieve this by supporting the replication of these successful pilot projects in other regions of the country. In addition to the four MHOs created in the Western Province, fourteen others have already been established in the Ngaoundere health district in the Adamawa province in partnership with UNICEF. Membership figures, according to a local newspaper report, "are revealing that mutual health organizations are a response to a real need." Although still very new, these MHOs already have more than 4,000 beneficiaries, 75 percent of whom are women and children. SAILD and AWARE-RH conducted training sessions for the newly elected MHO managers to help them better manage the MHOs and to negotiate health services packages with health providers effectively. The two organizations also continue to monitor and provide technical assistance to these newly created MHOs.
The health sector in the central West African republic of Cameroon is being transformed through multidimensional support from the USAID-funded Action for West Africa Region-Reproductive Health (AWARE-RH) project. This five-year cooperative agreement, designed to reinforce regional institutions and capacity to address reproductive health and child survival, is managed by EngenderHealth, working in partnership with Abt Associates, Academy for Educational Development (AED), and Management Services for Health (MSH).
