The Union des Mutuelles de Santé de Guinée Forestière (UMSGF) is an association of mutual health organizations (MHOs). It was established as part of a health insurance program initiated in 1999 by the International Centre for Development and Research (CIDR). Overall, the insurance sector in Guinea is underdeveloped and neither the target populations nor health care providers are particularly familiar with health insurance. This case study analyses the positive and negative aspects of the UMSGF.