Mandatory membership of community-based mutual health insurance in Senegal: A national survey

Abstract

With the low adhesion to voluntary mutual health insurance, Senegal’s policymakers have sought to understand the feasibility of compulsory health insurance membership. This study aims to measure the acceptability of mandatory membership in community-based mutual health insurance (CBHI) and to understand its possible administrative modalities. The study consists of a national survey among a representative population sample selected by marginal quotas. The survey was conducted in 2022 over the phone, with the random composition method among 914 people. The questionnaire measured the socio-economic characteristics of households, their level of acceptability concerning voluntary and compulsory membership, and their level of confidence in CBHIs and the health system. Respondents preferred voluntary (86%) over mandatory (70%) membership of a CBHI. The gap between voluntary and compulsory membership scores was smaller among women (p=0.040), people under 35 (p=0.033) and people with no health coverage (p=0.011). Voluntary or compulsory membership was correlated (p=0.000) to trust in current CBHIs and health systems. No particular preference emerged as for the preferred administrative channel (e.g. death certificate, identity card, etc.) which could enable to enforce the mandatory character. The results confirmed the well-known challenges of building universal health coverage on the basis of CBHIs, a model which is poorly appreciated and whose low performance reduces the acceptability of populations to adhere to it, be it on a voluntary or mandatory basis. Suppose Senegal persists in its health insurance approach. In that case, it will be essential to strengthen the performance and funding of CBHIs, and to gain population trust to enable a mandatory or more systemic membership.

Competing Interest Statement

None

Funding Statement

This research is part of the Unissahel program (Universal Health Coverage in Sahel) funded by the Agence Française de Développement (AFD) and another grant has been supported by the Wallonie Bruxelles International (WBI). The opinions expressed are exclusive of the authors and do not reflect the official position of the AFD and WBI.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The research was accepted by Senegal’s National Health Research Ethics Committee (42/MSAS/CNERS/SP/2021).

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data are presented in the paper

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