Community Based Health Insurance Schemes: Lessons from Rural Kenya

BACKGROUND: Health care costs are often a hindrance to seeking health care. Community-based health care insurance schemes (CBHIS) is a suitable alternative to conventional health insurance schemes which are often beyond the budget of majority of rural residents in Africa. Following establishment of a model CBHIS in the Samburu district in northern Kenya in 1988, initial membership rose from 12 to 218 households within 18 months but dropped to below 50 households by end of the 18th year. Samburu residents are mainly semi-nomadic pastoralist people dispersed into small nomadic communities across vast stretches of difficult terrain. OBJECTIVE: The objective of the survey was to assess Samburu CBHIS and give recommendations on how to rejuvenate the scheme. DESIGN: A cross-sectional study was conducted using qualitative and quantitative methods. RESULTS: The community has a poor understanding of the mechanism of CBHIS; little trust for scheme; and believes the scheme is expensive. CONCLUSIONS: There is need to create awareness on the operations of a health insurance scheme and engage community in redesigning of the scheme.