One of the most interesting and controversial debates in global health is that of financing. Everyone can see that there is a lot of work to be done and many have ideas on what to do, but with such limited funding, it is nearly impossible to make real, sustainable change in the field. The biggest issue around financing lies in the developing world, where there is a higher burden of disease without an equitable amount of spending (Gottret, 2006). Many models have been proposed and attempted to answer this central question. One that has worked successfully in rural areas, which are characterized by poverty and inaccessibility, is community based health insurance
Community based health insurance (CBHI) programs are becoming models of universally accessible, equitable healthcare (Donfouet, 2011). ). These programs are financed voluntarily through a prepaid premium from community members, which then cover services to be rendered in the future. This local community-financing works to generate revenue, which increases supplies and staff (something that is rare in this rural locations), and decrease out-of-pocket expenses, reducing barriers for the poor. This funding also brings services and staff to the rural areas, providing services for those unable to afford transportation costs or the expense of not working. These types of programs have financial benefits for the poor as it decreases catastrophic health spending and reduces the impact of ill health.
Although this type of financing is not the solution to the global health financing problem, it has the chance to be effective in smaller communities. In a smaller community, there is more interconnectedness and the disability of death of a neighbor can have a bigger impact on the community-such as loss of labor or in production, demand for services, and general health of the community (Jutting, 2003). Smaller communities are therefore more likely to invest in this type of healthcare, as a greater social connection exists.
There are, of course, some problems associated with CBHI, including the most destitute still being unable to pay the premiums. Other problems include the skill level of healthcare professionals and quality of care that would exist from limited funds in smaller, poorer communities (Carrin, 2005). Some of the solutions to these problems may be government subsidies for the poorest who cannot afford the premium (Jutting, 2003) or using these CBHIs as an entry into larger risk pooling systems (Carrin, 2005). This reduced government subsidization could improve the incentives for staff and the benefit packages available, while at the same time including the most-at risk.
There have also been many successes in establishing these programs internationally, from the success of Gonoshasthaya Kendra inBangladesh(Hsiao, 2004) to those inWest Africa(Bennett, 2004). There needs to be more research and more experiments, but this is an innovative way to resolve some of the biggest issues in global health today.
Bennett, S., Kelley, A., & Silvers, B. (2004). 21 Questions on CBHF: An Overview of Community Based Health Financing.Bethesda,MD: Partners for Health Reform Plus.
Carrin, G., Waelkens, M., & Criel, B. (2005). Community-based health insurance in developing countries: a study of its contribution to the performance of health ﬁnancing systems. Tropical Medicine and International Health 10(8): 799–811.
Donfouet, H. et al. (2011). The determinants of the willingness-to-pay for community-based prepayment scheme in rural Cameroon. Int J Health Care Finance Econ 11:209–220.
Gottret, P., & Schieber, G. (2006). Health Financing Revisited: A Practioner’s Guide.The International Bank for Reconstruction and Development / The World Bank.
Hsiao, W. (2004) Experience of community health financing in the Asian region. In A. Preker and G. Carrin (eds), Health financing for poor people: resource mobilization and risk sharing, vol 434 (119-155). World Bank Publications.
Jutting, J. (2003). Do community-based health insurance schemes improve poor people’s access to health care? Evidence from rural Senegal. World Development 32(2): 273–288.