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Community-based health insurance knowledge, concern, preferences, and financial planning for health care among informal sector workers in a health district of Douala, Cameroon

JJN Noubiap
WYA Joko
JMN Obama
JJR Bigna


Introduction: For the last two decades, promoted by many governments and international number in sub-Saharan Africa. In 2005 in Cameroon,
there were only 60 Community-based health insurance (CBHI) schemes nationwide, covering less than 1% of the population. In 2006, the Cameroon government adopted a national strategy aimed at creating at least one CBHI scheme in each health district and covering at least 40% of
the population with CBHI schemes by 2015. Unfortunately, there is almost no published data on the awareness and the implementation of CBHI
schemes in Cameroon.

Methods: Structured interviews were conducted in January 2010 with 160 informal sectors workers in the Bonassama health district (BHD) of Douala, aiming at evaluating their knowledge, concern and preferences on CBHI schemes and their financial plan to cover health costs.

Results: The awareness on the existence of CHBI schemes was poor awareness schemes among these informal workers. Awareness of CBHI schemes was significantly associated with a high level of education  (p=0.0001). Only 4.4% of respondents had health insurance, and specifically 1.2% were involved in a CBHI scheme. However, 128 (86.2%) respondents thought that belonging to a CBHI scheme could facilitate
their access to adequate health care, and were thus willing to be involved in CBHI schemes. Our respondents would have preferred CBHI schemes
run by missionaries to CBHI schemes run by the government or people of the same ethnic group (p).

Conclusion: There is a very low participation in CBHI schemes among the informal sector workers of the BHD. This is mainly due to the lack of  awareness and limited knowledge on the basic concepts of a CBHI by this target population. Solidarity based community associations to which the vast majority of this target population belong are prime areas for  sensitization on CBHI schemes. Hence these associations could possibly federalize to create CBHI schemes.