Integration of Emergency Transport Coverage into Community-Based Health Insurance Schemes

Swiss TPH and the Burkinabè NGO ASMADE are integrating emergency transport coverage into ten community-based health insurance schemes (CBHIs, locally known as mutuelles sociales) in the Bankui and Oubri regions of Burkina Faso. The project is co-funded by the Swiss Capacity Building Facility (SCBF).

In Burkina Faso, CBHIs remain one of the few health insurance options for rural and informal-sector households. The national universal health insurance scheme (RAMU), established in 2015, is not yet fully operational. Out-of-pocket payments account for around 45% of total health expenditure, and maternal mortality remains high at 198 deaths per 100,000 live births (DHS 2021).

CBHIs cover consultations, hospitalisation, maternity care and medicines, but not the journey to reach them. More than 37% of the population lives over 5 km from a health centre, often on poor roads. No public mechanism covers emergency transport from the household to the primary health centre. In emergencies, families rely on donkey carts, walking or overloaded motorcycles. Insured households therefore still face delays and catastrophic transport costs, which weakens the value of membership.

The project aims to close this gap by treating emergency transport as an insurable benefit. The benefit extends the existing CBHI package rather than creating a separate product. It includes:

  • Cashless coverage of emergency transport costs;
  • Pre-contracted providers (motorcycle taxis, ambulances, community vehicles);
  • 24/7 activation through community alert mechanisms (hotlines, community health workers, CBHI focal persons);
  • Continuity from transport to treatment under the schemes’ existing agreements with health facilities.

The project runs over 15 months in three phases:

  • Design and preparation (November – December 2026): feasibility study and baseline; design and pricing of the transport benefit for each scheme; identification and contracting of transport providers.
  • Implementation (January – December 2027): training of CBHI staff, elected leaders and transport providers; social mobilisation and community sensitisation, with targeted outreach to women and vulnerable households; continuous monitoring.
  • Consolidation and dissemination (January 2028): capitalisation of lessons learnt; advocacy with health authorities at regional and national level; dissemination of results.

Together, the ten schemes serve a catchment population of around 400,000. Enrolment is expected to grow from 3,199 to 12,000 members by project end, around two-thirds of them women. The project also tracks whether coverage translates into care (transports completed, response time from alert to pick-up, member retention). It also tracks whether the schemes can manage the benefit without external support. Evidence comes from routine transport and enrolment data and from baseline, mid-term and endline mixed-methods evaluations. The project will produce cost and utilisation data on emergency transport coverage that do not yet exist in Burkina Faso. These data will provide a basis for pricing the benefit in other schemes and for discussions with the national health insurance fund (CNAMU) on integrating transport into RAMU.

The project pays particular attention to women, especially pregnant women, and to children under five. These groups are the most exposed to delays in reaching care during emergencies.

The approach draws on comparable mechanisms in Tanzania (DharuraFasta) and Cameroon (Chèque Santé), to which Swiss TPH experts have contributed. The direct implementation partners are:

  • ASMADE, implementing partner, which has supported the creation and strengthening of CBHIs in Burkina Faso for three decades;
  • The ten participating CBHIs, which carry the new benefit;
  • The national federation of community mutual health organisations (FEMUSCO-BF), for advocacy;
  • Health facilities and contracted transport providers in the project area.

The project works closely with the Ministry of Health and CNAMU.

Project facts

Partners