Summary

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 allow 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 CBHI 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. 

This document synthesizes these findings, organized into three main sections as outlined below: 

• The first section provides definitions of social health protection and mutual insurance to delineate the scope of the work. 
• The second section offers an overview of the role of mutuals and CBHI within social health protection systems, drawing particularly on the aforementioned scoping review and the case studies conducted in seventeen countries. 
• The third section focuses on delegated management and presents various lessons learned from these experiences, particularly regarding the current and potential role of mutual health insurance within the framework of the West African Economic and Monetary Union (UMEOA).

This synthesis is followed by detailed case studies for each country.