Community-Based Health Insurance (CBHI): The Perils of Reaching Out to the Informal Economy

Social protection in low- and middle-income countries tends to focus one-sidedly on people in formal employment, while excluding informal workers. Policy responses to this coverage gap are constrained by fiscal and administrative challenges. In this context, there is growing attention for the potential of contributory social protection schemes that mobilize resources from within the informal economy. A prime example is community-based health insurance (CBHI), which is now a popular mechanism for extending social health protection to the informal and rural economy. At the same time, CBHI-schemes continue to face important challenges in relation to scheme uptake and premium collection. Relying on case study evidence from Senegal and Tanzania, this brief sketches how CBHI-schemes attempt to deal with these challenges, and makes a number of recommendations for external actors that wish to support the development of more effective systems of contributory social protection.

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B. Verbrugge

A. Adeline

J. Van Ongevalle