[Health insurance in Africa: a straw for the health care system].

Health Care Systems Clutch at a Straw: The health care systems of sub-Saharan Africa are facing a global crisis which is severely challenging their survival. Currently, alternatives to the traditional financing of health care by government grants and/or "fee for service" are sought. Otherwise the vast majority of poor rural inhabitants of these countries will lose access to Western medicine at the end of this century, making appropriate medical care a privilege of a small number of rich urbans. One approach to solving this crisis is the introduction of a health insurance system. However, the culture of African people must also be considered if one attempts to design and implement an insurance scheme. This paper reflects some of the problems of health insurance in an African context. Since the author contributed to the design of a "Community Based Health Insurance" of the Evangelical Lutheran Church in Tansania, this scheme is used here as an example.