Community-based health insurance knowledge, concern, preferences, and financial planning for health care among informal sector workers in a health district of Douala, Cameroon

Abstract

INTRODUCTION: For the last two decades, promoted by many governments and international organizations, community-based health insurance (CBHI) schemes have been growing in number in sub-Saharan Africa. In 2005 in Cameroon, there were only 60 CBHI schemes nationwide, covering less than 1% of the population. In 2006, the Cameroon government adopted a national strategy aimed at creating at least one CBHI scheme in each health district and covering at least 40% of the population with CBHI schemes by 2015. Unfortunately, there is almost no published data on the awareness and the implementation of CBHI schemes in Cameroon. METHODS: Structured interviews were conducted in January 2010 with 160 informal sectors workers in the Bonassama health district (BHD) of Douala, aiming at evaluating their knowledge, concern and preferences on CBHI schemes and their financial plan to cover health costs. RESULTS: The awareness on the existence of CHBI schemes was poor awareness schemes among these informal workers. Awareness of CBHI schemes was significantly associated with a high level of education (p=0.0001). Only 4.4% of respondents had health insurance, and specifically 1.2% were involved in a CBHI scheme. However, 128 (86.2%) respondents thought that belonging to a CBHI scheme could facilitate their access to adequate health care, and were thus willing to be involved in CBHI schemes. Our respondents would have preferred CBHI schemes run by missionaries to CBHI schemes run by the government or people of the same ethnic group (p=0.0001). The majority (75.4%) of respondents preferred monthly premiums. The mean amount they were willing to pay as monthly insurance premium was 704-737 CFA francs/charge (1.39-1.45 USD). A hundred and ten (68.7%) respondents belonged to a solidarity based community association, and most of them (86.9%) said they would accept to fuse their individual associations to create a CBHI scheme. CONCLUSION: There is a very low participation in CBHI schemes among the informal sector workers of the BHD. This is mainly due to the lack of awareness and limited knowledge on the basic concepts of a CBHI by this target population. Solidarity based community associations to which the vast majority of this target population belong are prime areas for sensitization on CBHI schemes. Hence these associations could possibly federalize to create CBHI schemes.

Keywords

• community-based health insurance
• knowledge
• concern
• preferences
• informal sector workers
• cameroon