“To enrol or not to enrol?”: A qualitative investigation of demand for health insurance in rural West Africa

• Published in: Social science & medicine (1982) Vol. 62; no. 6; pp. 1520 - 1527
• Main Authors: De Allegri, Manuela, Sanon, Mamadou, Sauerborn, Rainer
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.03.2006; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Adult; Africa; Aged; Biological and medical sciences; Burkina Faso; Community; Community-based health insurance; Decision making; Demand; Developing Countries; Ethnic Groups; Female; Health; Health care policy; Health Insurance; Health insurance Africa Demand Community-based health insurance Burkina Faso; Health Services Accessibility - organization & administration; Humans; Insurance, Health - utilization; Low income groups; Male; Medical sciences; Medicine; Middle Aged; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative analysis; Qualitative Research; Quality of Health Care - organization & administration; Social sciences; Sociocultural Factors; Socioeconomic Factors; West Africa; West Africa; Burkina Faso; Africa; Demand; Health insurance; Community-based health insurance; Burkina Faso; Africa; Rural environment; Welfare aids; Community health; Social aspect; Public health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2005.07.036

In spite of the fact that feeble levels of participation have long been identified as a major constraint to the successful long-term implementation of community-based health insurance (CBI) in low-income countries, evidence on determinants of enrolment in CBI is still lacking. The application of econometric modelling has provided a partial answer to the question, but on its own it has proved to be insufficient to guide policy making. This paper aims to fill this gap in knowledge using qualitative research methods. In-depth interviews with 32 household heads were conducted in the Nouna Health District, Burkina Faso, West Africa to assess determinants of enrolment in a newly established CBI scheme. The findings highlight that factors previously neglected in the literature, such as institutional rigidities and socio-cultural practices, play an important role in shaping the decision to enrol. The discussion of the findings focuses on the policy implications, offering concrete recommendations to maximise enrolment, within and beyond Burkina Faso.