Skip to main content

Table 5 Identified problems and solutions, December 2003

From: An in-depth investigation of the causes of persistent low membership of community-based health insurance: a case study of the mutual health organisation of Dar Naïm, Mauritania

Problem Discussed solutions Implementation
Ineffective procedures for premium collection: Comprehensive revision of procedures for premium collection:  
- Monthly collection - Annual collection
- Close follow-up of due renewals
- Option from 2008 onwards
- No close follow-up
- Transport to be paid by volunteers - Monthly tour of all zones by the manager - Successfully executed during several months, then interrupted
- Many delegates are discouraged by demanding tasks - Replacement of inactive delegates
- Transfer of tasks from volunteers to the paid manager
- No replacements
- No explicit transfer of tasks; in practice some tasks were taken on by the manager
- Mismanagement of funds by some delegates - Enactment of sanctions as stipulated in the Statutes - No sanctions; individual discussions by the President of the MHO
Complicated procedures for proving entitlement when seeking care Abolishment of the ‘guarantee letter’ proving entitlement and timely distribution of lists of active beneficiaries to care providers - Abolished in 2007
- Timely distribution of lists from 2008 onwards
Poor understanding of multiple and complicated rules and regulation - Better information of leaders, delegates and members about procedures, rights and obligations
- Simplification of procedures where possible
- Several training sessions for scheme leaders and delegates
- Regular information campaigns
Disinformation by recruiters with the aim to register high numbers New information campaign; open exchange with members about the initial disinformation by some Dynamic and candid information campaign in 2004
Distrust of members resulting of insufficient information, disinformation and mismanagement of funds New information campaign; transparency; better communication; promotion of participation and ownership Several information campaigns; no change in communication style, participation and feeling of belonging and ownership
No perception of belonging and ownership by members Regular meetings with members in each zone to discuss health subjects of general interest - Done during several months
- Successfully done in the zone of Zaatar
Poor performance of delegates in positions of responsibility, who had expected personal rewards - Replacement of inactive delegates by motivated candidates
- Abolishment of bureaux de zone
- No replacement of delegates
- No explicit changes in the role of the bureaux de zone
Exclusion of the poorest and large households; disinterest of wealthier households - Creation of an equity fund
- Redefinition of ‘the household’
- Discounts for large households
- Targeted information campaigns
- Advocacy with municipal administration to integrate the MHO among other public services
- Done in 2005
- Spontaneous evolution towards the nuclear family
- No discount for large households
- No campaigns to attract the wealthier
- No rapprochement with municipal administration
Inaction of scheme leaders when faced with unexpected problems - Responsive management aiming at problem solving and members’ satisfaction
- Continuing education
- Leaders tried to improve implementation of initial strategies; no change in management style
- Frequent training workshops until 2008