VOLUNTARY HEALTH-INSURANCE IN BWAMANDA, DEMOCRATIC-REPUBLIC OF CONGO - AN EXPLORATION OF ITS MEANINGS TO THE COMMUNITY

An insurance scheme revering hospital care in the rural district of Bw amanda in the North-west of the Democratic Republic of Congo, which lo cally is called the mutuelle, was conceived and developed in 1986 on t he initiative of Belgian doctors working in the district under the arr angements for bilateral Belgian aid. After Inure than 10 years of oper ation the Bwamanda scheme has achieved a high rate of coverage, contri buted to 3 significant improvement in access to hospital-based in-pati ent care, and constitutes a stable source of revenue for the operation of the hospital. We present an investigation conducted through focus groups in 1996 of the population's social perceptions of this risk-sha ring scheme to identify ways to improve it. The findings pertain to th e reasons for people resubscribe to the scheme; to the perception of i ts redistribution effects; to people's frustrations and questions; and finally to the relationships between the insurance scheme and traditi onal mutual aid arrangements. The difference between a hospital insura nce scheme ia logic of contract) and the traditional systems of mutual aid (a logic of alliance) is highlighted, and the impact of the hospi tal insurance scheme on social inequalities is discussed. The implicat ions of this study on the management of the Bwamanda health insurance scheme are reviewed, and this study may be useful to health managers w orking in similar contexts.