A prepaid healthcare scheme in rural Africa

Healthcare providers in Africa are having to increasingly rely on the resou rces of the populations they serve. An 8-year experience with one of the fi rst rural-based health insurance schemes in East Africa is described. initi al difficulties included adverse selection of members with chronic ill heal th, fraudulent claims and overuse of health services, leading to considerab le financial losses. External technical assistance introduced member tracki ng and regular reports, reduced adverse selection, fraud and overuse of ser vices to a minimum, and achieved financial stability. Local market research and a comprehensive marketing plan is essential for the overall success of an insurance plan. Health insurance in this part of Africa is likely to as sist middle income earners rather than the poor.