Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems


Bart Criel (corresponding author) and Maria-Pia Waelkens, Public Health Department, Institute of Tropical Medicine, 155, Nationalestraat 2000 Antwerp, Belgium. Tel.: +32 3 247 62 88; Fax: +32 3 247 62 58; E-mail:;
Guy Carrin, Department of Health Financing, Expenditure and Resource Allocation, World Health Organisation, 1211 Geneva 27, Switzerland. E-mail:


We studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. We present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.