Acceptability of an innovative mutual health scheme in central Mali:
research in mixed methods
As the Universal Health Insurance Plan (RAMU) is being implemented in
Mali, community-based health insurance (CBHI) — one of the pillars—
must innovate to meet the challenge of universal health coverage. An
experimental CBHI was tested in central Mali between 2017 and 2021. This
innovative CBHI professionalizes and organizes risk sharing on a larger
scale, moving from municipalities to circles (department). A
mixed-method study was carried out to assess the acceptability of this
innovation among elected representatives of CBHI offices. In April 2021,
118 questionnaires were administered, followed by 43 qualitative
interviews from the same sample in October 2021. Sekhon el al. (2017)
seven dimensions of acceptability was used as the conceptual model. More
than half of individuals (58%) reported above-average acceptability.
Elected officials feel well supported in their activities by the
Technical Union of Malian Mutuality (UTM), the umbrella organization of
CBHI. They show some confidence in their ability to perform their duties
effectively despite varying levels of commitment that often fall short
of expectations and needs, which they justify by their volunteer status.
Elected officials note that the system is very effective despite the
nonoptimal conditions linked to the prevailing insecurity.
Professionalization appears to be an unavoidable condition for the
performance of the innovation, as well as the new community assembly.
However, elected officials are concerned about the sustainability. The
UTM will play an important role in continuing its support and fulfilling
its functions as a delegated management organization within the
framework of the RAMU.