Study on Examining the Experience of the Country with the Main Voluntary Affiliation and Not for Profit Health Insurance Mechanisms in DRC

While several reforms are under way in the social welfare and health sector, including the development of social protection and health financing strategies, laws on mutual insurance, universal health coverage and social security, the Government, through the General Secretariat for Social Welfare (SG/PS), has requested that this study be carried out.

This study should contribute to the reflection underway in the DRC on the Universal Health Coverage (UHC) process.

This general objective has been broken down into three specific objectives which are as follows:
(i)  To take stock of the existence and performance of mutual health insurance schemes
(ii)  Analyze for the beneficiaries and for the entire target population :
      a. The coverage of the services offered
      b. The ability to protect financially
(iii) Identify the constraints and levers to capitalize on this experience. In this regard, the stakeholders expressed the wish to have recommendations with possible scenarios for the expansion of mutual health insurance.

The study methodology was developed and validated through a participatory process with the help of experts from the METPS and the MSP, and a validation workshop was organized at the end of 2015 with partners and representatives of organizations promoting mutual health insurance, under the direction of the consultant and the direct supervision of the SG/PS. The survey was conducted in the provinces with the formation of mixed teams from the central level and the provinces, the METPS and the MSP. Data collection was delayed for several reasons, including the need to repeat the survey in the city-province of Kinshasa.
Nine (9) mutual health insurance companies located in four (4) provinces were surveyed through interviews and focus groups with the population and interviews with key institutions in the sector, in the provinces and at the central level.
A workshop to validate the interim report resulted in inputs from the work of the sub-committees with a view to improving and enriching the report.
In the same vein, comments from the World Bank Group were sent to the consultant who, in addition, requested an internationally renowned expert in the field of mutual health insurance to contribute to the finalization of the report.

The study highlighted the following lessons learned in terms of levers and constraints for the expansion of mutual health insurance in the DRC:

(i)  A rich experience of mutual health insurance demonstrated by its history, diversity and active mutualist life (more than 100 mutuals; since the 1980’s; different models of development and organizations including grouped in networks).
(ii) A commitment by the State to the development and structuring of the mutualist system (Organic Law No. 17/002 of February 8, 2017 determining the fundamental principles of mutuality; significant State subsidies for the MESP (Mutual Health Insurance for Teachers in Primary, Secondary and Professional Education); Health strategy and plan including mutual health insurance).
(iii) Proven capacities within existing mutual health insurance companies and their support structures (organization of civil society with professionalized health insurance management, national program, possible synergies with performance purchasing agencies).

Constraints :
(i)  The challenges of regulating mutual health insurance (responsibilities between ministerial departments of health and social welfare and a context conducive to poor governance).
(ii)  Structural weaknesses of mutual health insurance (administrative and technical viability is affected by weak information systems; functional and financial viability is limited).

The recommendations for the expansion of mutual health insurance are grouped into four categories as follows:
(i)   Establish a mapping of mutual health insurance and their comprehensive support structures and monitor their performance.
(ii)  Ensure the regulation and promotion of the mutual health insurance sector by the State.
(iii) Strengthen the professional support structures of existing mutual health insurance schemes and support their creation where they do not exist.
(iv) Clarify the role of mutual health insurance in health financing and social protection strategies.

The study aims to provide elements of decision-making support to the Government and its partners.

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