LES MUTUELLES DE SANTÉ EN AFRIQUE SUB-SAHARIENNE ...

There is however not yet enough evidence for understanding the part of each of these factors and,
consequently, the appropriate interventions to amend them. Hence the need for further investigations.
Proposal for a research agenda
The prevailing framework for analysis of the performance of Mutual Health Organisations is largely
biased towards the technical aspects of the scheme itself. The human factor inherent to organisation,
management and interactions between partners is only superficially addressed. Another aspect that
receives too little attention is the context: the structural and socio-cultural environments in which the
schemes should operate.
The different synthetic reports found in the literature are based on a too small number of well-documented
experiences. In the absence of a sufficient number of in-depth case studies, the analysis is often guided by
theoretical concepts that are insufficie ntly validated by real-life observation of schemes in sub-Saharan
Africa.
The existing schemes should thus be better documented. However, a new framework for analysis that
goes beyond the restricted technical analysis should be developed. This framework should take into
account the social dimension, the demand, the opinion of different stakeholders, as well as the context in
which the scheme functions.
We advance the following hypothesis: in order to improve the performance of the schemes, the point is
not to design one ideal model, but to design a tailored scheme in each local context.
In order to propose a tailored scheme, more attention should be given to:
− the demand of the population;
− the integration of the schemes into the local health system;
− the integration into the social, economic and cultural environment.
The research agenda should be composed of the following elements:
1. Elaborate a framework for a comprehensive analysis for the planning, conception, implementation
and evaluation of Mutual Health Organisations;
2. Document the existing models; Develop and validate a single typology;
3. Improve our understanding of the reasons for the low subscription rates and of profitable action for
change:
− Comparison between members and non-members and between different schemes;
− An in-depth analysis of the most significant factors (quanlity of health care services, trust in the
chances for success and financial capacity);
− Action-research to test the feasibility and acceptability of solutions for the problems identified;
4. On the basis of well-documented experiences, determine the contextual particularities of both
successful and unsuccessful initiatives.
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