What role can health mutuals and community-based health insurance play in social health protection systems? : review of experiences

Social health protection systems are constantly evolving, offering a wide range of institutional, administrative, and financial arrangements. International standards in social health protection are outcome-based, and grant flexibility in the institutional and administrative arrangements chosen by each state to implement these guarantees, as long as certain fundamental principles are upheld. These principles include the establishment of state-guaranteed benefit entitlements, solidarity in financing, and broad risk pooling. The flagship Social Security (Minimum Standards) Convention, 1952 (No. 102), globally recognized as a reference for system design, is thus conceived around the idea that systems are adaptable and that no single model applies universally. At the global level, mutuals primarily focus on providing complementary or supplementary coverage to basic health schemes. Only a small number of countries incorporate mutuals and community-based health insurance (CBHI) into the architecture of their basic health coverage systems. This working paper explores various country experiences where mutuals and CBHI contribute to basic health coverage within national social protection systems. Despite a wealth of literature on mutuals and CBHI, little is known about the practical methods used to integrate them into national social health protection architectures. This work is based on a literature review (Niang et al., 2023) and seventeen case studies spanning countries in Europe, Africa, Asia, and Latin America. This comparative analysis highlights that the involvement of mutuals and AMBCs in national social health protection schemes is the result of a historical process unique to each country, evolves dynamically over time, and varies significantly in the conceptual and legal frameworks that govern them.