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.