Maternal and child health: The social protection dividend

Economic access to health services is the major obstacle to their use. Accordingly, setting up health financing schemes is the determining factor for improving access to health services, particularly for vulnerable groups.

This document reviews the strengths and weaknesses of the different types of health financing schemes in West and Central Africa. It shows that paying health services, in which users pay fees according to their use of services (degree and frequency of illness) and not according to their ability to pay, have the most negative impact on health. Inversely, health insurance systems are widely promoted, but they come up against major inherent limits in implementing them. In West and Central Africa, health insurance is only available for a small minority of people, working in the public or formal sector. High performance administrative capacities are needed to manage contributions and reimburse members. Health services must also be high quality to justify the contributions.

The trend is to set up more health insurance systems at a local level to reach people who are excluded from classic systems. However, it appears that it is not possible to guarantee universal access to primary health services on the basis of insurance schemes alone. Governments still need to increase expenditure to improve the quality and management of health services and subsidise them.

 UNICEF, ODI - May 2009