University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
Int J Equity Health. 2012 Dec 5;11:74. doi: 10.1186/1475-9276-11-74.
Mutual health organizations (MHO) have been implemented across Africa to increase access to healthcare and improve financial protection. Despite efforts to develop MHOs, low levels of both initial enrolment and membership renewals continue to threaten their financial viability. The purpose of this study was to map initiatives implemented to increase the pool of MHO members in Benin.
A multiple case study was conducted to assess MHOs supported by five major promoters in Benin. Three months of fieldwork resulted in 23 semi-structured interviews and two focus groups with MHO promoters, technicians, elected members, and health professionals affiliated with the MHOs. Fifteen non-structured interviews provided additional information and a valuable source of triangulation.
MHOs have adopted a wide range of initiatives targeting different entry points and involving a variety of stakeholders. Initiatives have included new types of collective health insurance packages and efforts to raise awareness by going door-to-door and organizing health education workshops. Different types of partnerships have been established to strengthen relationships with healthcare professionals and political leaders. However, the selection and implementation of these initiatives have been limited by insufficient financial and human resources.
The study highlights the importance of prioritizing sustainable strategies to increase MHO membership. No single MHO initiative has been able to resolve the issue of low membership on its own. If combined, existing initiatives could provide a comprehensive and inclusive approach that would target all entry points and include key stakeholders such as household decision-makers, MHO elected members, healthcare professionals, community leaders, governmental authorities, medical advisors, and promoters. There is a need to evaluate empirically the implementation of these interventions. Mechanisms to promote dialogue between MHO stakeholders would be useful to devise innovative strategies, avoid repeating unsuccessful ones, and develop a coordinated plan to promote MHOs.
Mutual health organizations (MHO) 已在非洲各地实施，以增加获得医疗保健的机会并改善财务保障。尽管为发展 MHO 做出了努力，但初始入保率和续保率均较低，这继续威胁着它们的财务生存能力。本研究的目的是绘制在贝宁实施的旨在增加 MHO 成员人数的计划。
采用多案例研究方法评估了贝宁五个主要推动者支持的 MHO。三个月的实地工作导致了 23 次与 MHO 推动者、技术人员、当选成员和与 MHO 相关的卫生专业人员的半结构式访谈以及两次焦点小组讨论。15 次非结构式访谈提供了额外的信息和宝贵的三角验证来源。
MHO 采取了广泛的举措，针对不同的切入点，涉及各种利益相关者。这些举措包括新型集体健康保险套餐，以及通过挨家挨户上门和组织健康教育研讨会来提高认识的举措。已经建立了不同类型的伙伴关系，以加强与卫生专业人员和政治领导人的关系。然而，这些举措的选择和实施受到了资金和人力资源不足的限制。
研究强调了优先考虑可持续策略来增加 MHO 成员的重要性。没有单一的 MHO 举措能够独自解决会员人数低的问题。如果将这些举措结合起来，可以提供一种全面和包容的方法，针对所有切入点，并包括家庭决策者、MHO 当选成员、卫生专业人员、社区领导、政府当局、医疗顾问和推动者等关键利益相关者。需要对这些干预措施的实施进行实证评估。促进 MHO 利益相关者之间对话的机制将有助于制定创新战略，避免重复失败的做法，并制定促进 MHO 的协调计划。
