Population Coverage: 400,000 Year Launched: 2011 Language: French Membership: Full Member

Targeting the poor.

Mali’s health system is largely centered on Mutuelles – non-profit groups that largely rely on dues from their members. Participation in Mutuelles is largely voluntary and organized at the community level.

The Context

The focus on reform from Mutuelles stems from two major geographic and demographic factors: the geographic dispersion of Mali’s population, and the high level of informal and agricultural sector employment.

Key Reforms

In 2000, institutional reforms created the National Social Protection and Economic Solidarity Department to strengthen the structural framework for the Mutuelle system. These included the Association Support Center, Mutuelle and Cooperative Societies (CAMASC). In 2002, the government of Mali adopted a national social protection policy, followed in 2004 by a national action plan to extend social protection for the 2005-2009 period.
In February 2011, the President of Mali and the Board of Ministries officially adopted the Universal Health Insurance scheme, which will provide comprehensive health care by merging three existing systems: Coverage for the formal sector, medical assistance for the indigenous population, and Mutuelle health organizations for the informal sector. The new policy will bolster current Mutuelle (or CBHI) schemes in Mali, which currently cover 2% of the population. The first phase of the roll-out of the standardized national CBHI approach will include three of the eight regions in Mali (Sikasso, Ségou and Mopti) with a targeted number of beneficiaries in the first phase being approximately 1.2 million people, or about 40% of the target population in the three regions.
The implementation of this national community-based health insurance policy is challenging. New agencies and systems are in the process of acquiring the necessary skills to carry out tasks such as collecting and managing resources, purchasing services, rulemaking, and process monitoring and evaluation.

Shortly after the launch of several Mutuelle pilots in Mali, managers of the Union Technique de la Mutualité Malienne (UTM) participated in their first Joint Learning Network for Universal Health Coverage (JLN) Workshop in Mombasa, Kenya in July 2011. The workshop focused on sharing creative approaches and best practices on expanding coverage. After the workshop, Mali became a member of the JLN and signed an MOU to confirm institutional support for network participation. In the ensuing years, Mali has been a participant in the Expanding Coverage and Primary Health Care initiatives, as well as representative on the JLN Steering Group.

Impact: Cross-Country Knowledge Sharing

In June 2011, managers of the Union Technique de la Mutualité Malienne (UTM) participated in their first JLN Workshop in Mombasa, Kenya, where they learned about the Kenya National Hospital Insurance Fund’s (NHIF) use of M-Pesa, the well-known mobile payment platform, to collect health insurance premiums from informal sector populations. Upon returning to Mali, UTM managers were inspired to explore mobile money as a potential tool to collect health insurance premiums in Mali. In September 2013, UTM launched its mobile money application for premium payments for the Mutuelle.

As of June 2014, 300+ Mutuelle members from across the country had paid premiums via mobile money, resulting in 500+ mobile money transactions. UTM and Mali’s Mutuelles aim to increasingly use mobile money to collect and manage premium payments, particularly as the mobile money ecosystem continues to develop in Mali and membership in Mutuelles expands. UTM is also exploring a mobile-based payment mechanism to send claims payments to health providers.

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