This case study is about an institution that is owned, controlled and used by very humble people (street vendors, subsistence farmers, unemployed women, semi-nomad shepherds, among others), living in one of the poorest countries in Africa, Mali. It is a case study about mutual health organizations1 (MHO) that have started to spring into existence in urban and rural West Africa (mostly French speaking) and provide health insurance to hundreds of thousands of people, up from a few tens of thousands just five years ago. But, while its growth and impact on members is impressive, the mutual movement is struggling to survive and consolidate itself, just like the people it serves. In this movement, the existence of an apex organization capable of providing services needed by individual MHOs is crucial. But the means to support this apex are hardly available. Small variations in economic conditions (e.g., a drought, a flood, locusts) can cause many members to discontinue paying their premiums. This forces them to re-initiate, many months later, the expensive procedure of registration or leads them to abandon coverage altogether.
CGAP Working Group on Microinsurance