Published: 2022-02-28

Community-based mutual aid for improving financial access tos healthcare: case study of 150 community-based organizations in Cameroon

Flaubert Fouakeng, Zakariaou Njoumemi, Wilfred F. Mbacham, Fru Angwafo III


Background: Financial access to health care has been sharply reduced in Africa following the introduction of cost recovery recommended by the Bamako initiative of 1987. Like in many countries in the world, in Cameroon, community-based organizations (CBO) which assist their members in the event of a financial crisis, death, funeral, birth, marriage, etc. added financial assistance in case of illness to alleviate this situation. This study aimed to determine models of financial assistance practiced by these organizations to rescue their members in event of illness.

Method: Study was based on a sample of 150 CBO selected for convenience in 3 zones, including 50 in urban areas, 50 in semi-urban areas, and 50 in rural areas. Previously trained interviewers organized group discussions to collect data from these organizations using structured interview guide. The analysis of data collected was done manually.

Results: The results show that 82.66% of organizations practice the "rescue quest model", 10.67% the "lump sum health assistance model", 2.67% "health tontine model", 2% "sickness deposit model", and 2% "subcontracting model" with an insurance company. The analysis shows that the "health tontine" and "sickness deposit" models are more forward-looking because they can make money available in time, before seeking care/before  disease worsens.

Conclusions: The systematization of these models could make it possible to mobilize funds on a community basis to extend the coverage of the financial risk linked to the disease to the populations of the informal and rural sector.


Community-based mutual aid, Financial access to healthcare, CBO

Full Text:



UN HLM. A history of Universal Health Coverage in the UN. 2019. Available at: Accessed 11, November 2021.

WHO. New perspectives on global health spending for universal health coverage. 2018, WHO/HIS/HGF/HFWorkingPaper/18.2.

Gorsky M, Sirrs C. The Rise and Fall of “Universal Health Coverage” as a Goal of International Health Politics, 1925-1952. Am J Public Health. 2018;108(3):334-2.

Ridde V, Girard JE. Douze ans après l’Initiative de Bamako: Constats et implications politiques pour l’équité d’accès aux services de santé des indigents africains. Revue Santé Publique. 2004;16(1):37-61.

Tizio S, Flori YA. De la gratuité à la tarification des soins en Afrique Subsaharienne : grandeur et décadence de l’objectif « santé pour tous. INIST CNRS. 1997;1-30.

Gbedonou P, Moussa Y, Floury B, Josse R, Ndiaye JM, Diallo S. L’Initiative de Bamako : Espoir ou illusion. Réflexions autour de l’expérience Béninoise. Cahiers Santé. 1994;4:281-8.

McPake B, Hanson K, Mills A. Community financing of health care in Africa: An evaluation of the Bamako Initiative. Social Sci Med. 1993;36(11):1383-95.

Carrin G, Waelkens MP, Criel B. Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems. Trop Med Int Health. 2005;10(8) :799-811.

Commeyras. Problématique du médicament au Cameroun : Etat des lieux de l’offre, de la demande, des prix de vente et perspectives pour améliorer l’accessibilité financière. Bul Liais. DOC. OCEAC. 2000;33(4):24-9.

Kakama AA, Namyalo PK, Basaza RK. Feasibility and desirability of scaling up Community–based Health Insurance (CBHI) in rural communities in Uganda: lessons from Kisiizi Hospital CBHI scheme. BMC Health Serv Res. 2020;20:662.

Shigute Z, Mebratie AD, Sparrow R, Alemu G, Bedi AS. The Effect of Ethiopia’s Community-Based Health Insurance Scheme on Revenues and Quality of Care. Int J Environmental Res Public Health. 2020;17(22):8558.

Bhat R, Menezes L, Avila C. Review of Community/Mutual-Based Health Insurance Schemes and Their Role in Strengthening the Financial Protection System in India. Published by USAID and Health Finance & Governance in August 2017. Available at: Accessed on 10, November 2021.

Agonafer EP, Carson SL, Nunez V, Poole K, Hong CS, Morales M et al. Community-based organizations’ perspectives on improving health and social service integration. BMC Public Health. 2021;21:452.

Embleton L, Shah P, Gayapersad A, Kiptuid R, Ayukude D, Wachira J et al. Recommendations for improving access to healthcare for street-connected children and youth in Kenya: A qualitative study. Children and Youth Services Rev. 2021;131:106302.

Health Affairs Blog. "Health Care and Community-Based Organizations Have Finally Begun Partnering to Integrate Health and Long-Term Care", Health Affairs Blog. 2018.

Aveling EL, Martin G, Herbert G, Armstrong N. Optimising the community-based approach to healthcare improvement: Comparative case studies of the clinical community model in practice. Social Sci Med. 2017;173:96e103.

Kunkel SR, Straker JK, Kelly EM, Lackmeyer AE. Community-based organizations and health care contracting: research brief. Oxford (OH): Scripps Gerontology Center. 2017;1-4

Parikh RB, Montgomery A, Lynn J. The Older Americans Act at 50-community-based care in a value-driven era. N Engl J Med. 2015;373(5):399-401.

Aboubakar KY, Develtere P. Mutuelles de santé au Cameroun : Etude comparative ; Rapport réalisé pour la Coopération Technique Belge. Yaoundé, Cameroun: Coopération Technique Belge ; Leuven, Belgique : Leuven Katholieke Universiteit. 2003. Available at: Accessed 10, June 2020.

Kotto HE. L’extension de la sécurité sociale aux populations non couvertes : Rapport du Cameroun. Colloque des directeurs d’institutions de sécurité sociale des pays francophones d’Afrique, Limbe-Cameroun du 28 au 30 janvier 2004. Genève, Suisse : Association Internationale de la Sécurité Sociale. 2004. Available at: https://www.usp2030. org/gimi/;jsessionid=AkDc5OlGETWtrmml341oL5vzvz9bWy0rZseIZPYG5x9Ls7WVPiqV!-435584484?id=23311. Accessed on 15, June 2020.

Donfouet HP, Mahieu PA. Community-based health insurance and social capital: a review. Health Econ Rev. 2012;2(1):5.

Jütting Jp. Do Community-based Health Insurance Schemes Improve Poor People’s Access to Health Care? Evidence From Rural Senegal. World Development. 2003;32(2):273-88.

Fezeu M. Inventaire des mutuelles de santé en Afrique de l’ouest et du centre : cas du Cameroun (rapport de consultation). Yaoundé, Septembre 2000. Bulletin d’information de la Concertation. 2000. Available at:;jsessionid=EtlZGjo3k3igwhSpnZPoo-Bz_zp0hWs7m5rN2dD6jvxcE-1jYv4i!1653088929?id=18230. Accessed 15, June 2020.

BIT/STEP. Contribution actuelle et potentielle des mutuelles de santé. Bureau International du Travail, 2001;12-3.

Doris W, Jütting JP. The Emerging Movement of Community Based Health Insurance in Sub-Saharan Africa: Experiences and Lessons Learned. Afrika spectrum. 2000;352:1-19.

Adebayo EF, Ataguba JE, Uthman OA, Okwundu CI, Lamont KT, Wiysonge CS. Factors that affect the uptake of community-based health insurance in low-income and middle-income countries: a systematic protocol. BMJ Open. 2014;4(2):e004167.

Bhat R, Menezes L, Avila C. Review of Community/Mutual-Based Health Insurance Schemes and Their Role in Strengthening the Financial Protection System in India. Published by USAID and Health Finance and Governance. 2017.

Bennett S. The role of community-based health insurance within the health care financing system: a framework for analysis. Health policy planning. 2004;19(3):147-58.