Solidarity in Community-Based Health Insurance in Senegal: Rhetoric or Reality

ABSTRACT

Continued low rates of enrolment in community-based health insurance (CBHI) suggest that in many countries strategies proposed for scaling up have not been well-designed or successfully implemented. One reason may be a lack of systematic incorporation of social and political context into CBHI policy. In this study; solidarity in CBHI is analysed from a sociological perspective in order to answer the following research questions What are local definitions and perceptions of solidarity in CBHI? To what extent are these borne out in practice? Three case studies of Senegalese CBHI schemes using specific criteria were studied. Transcripts of interviews with 64 CBHI stakeholders were analysed using inductive coding. A conceptual framework of four dimensions of solidarity (health risk; vertical equity; scale and source) was developed to interpret the results. The results suggest that the concept of solidarity in CBHI is complex. Each dimension and source of solidarity was either not borne out in practice or highly contested; with views diverging between stakeholders and the target population. This suggests that policy-makers need to engage in a more rigorous public discussion of solidarity as regards CBHI and universal health coverage policy more widely; in order to move towards policies which both resonate with and meet the expectations of the people they aim to serve