Determinants of health insurance coverage in the informal sector in Mali: the case of the urban commune of Kou Tiala, Sikasso region (Mali)

Abstract

Mali has opted for mutual health insurance to cover the informal sector as part of universal health coverage. To encourage membership, the state provides subsidies through financial and technical support. Thus, to encourage the sector to join, the state covers half of members' contributions. However, the rate remains low and was 5% following an evaluation conducted in 2015. To understand the reasons for this low coverage, we initiated this study, the objective of which is to analyze the determinants of membership. To do this, we conducted a qualitative study with the beneficiaries and stakeholders involved in the implementation of the mutual insurance. We conducted in-depth individual interviews and focus groups with 33 people. Content and thematic analyses were carried out using an analytical grid. We arrived at the following results: on the beneficiary side: lack of awareness of the mutual insurance company, lack of information on co-financing, failure to take into account members' complaints, limited choice of healthcare structures; difficulty in mobilizing co-financing and contributions, volunteering are, according to the stakeholders, factors that limit membership. In conclusion, managers must develop partnerships with farmers' organizations and local radio stations to better raise awareness among the population in order to increase the membership rate.