Community Based Health Insurance Schemes (CBHIs) in Health Care Financing: Review of Experiences of the Asian and African Economies

Abstract

The WHO World Health Assembly and the World Health Report (2010) have called for all health systems to move towards universal health coverage. This is a challenge for the resource-scarce low and middle income countries. Health related expenses remain the most important reason for households being pushed below poverty line (Xu et al; 2003, 2007). One alternative to covering poor people in the informal sector is to involve them into Community Based Health Insurance Schemes (CBHIs). Scholars and practitioners have expended substantial effort on investigating the effectiveness and sustainability of CBHIs, the challenges faced by them, the solutions for improvement and the potential role of the CBHI in a national financing strategy to achieve universal coverage in low income countries. The present paper first describes the development of CBHIs through an evolutionary perspective and then highlights the significant factors essential to integrate the CBHI into the national financing strategy (Bennett, 2004;Wang and Pielemeier, 2012). Using this framework, the second section undertakes a review of CBHIs in selected countries in Asia and Africa to identify key contributing and/or challenging factors faced by CBHIs in each stage. The study provides recommendations on how to adopt characteristics to transform fragmented CBHI initiatives towards achieving universal coverage.