When driving from the centre of Kinshasa to N’djili Airport, the submunicipality of Masina is on your right, at the point where the busy road turns into a road of dust, dirt and rubble. Masina has a population of 800,000. This is also Kinshasa, beyond the richer city centre with its wide boulevards. While poor, it is perhaps not the city’s poorest district.
We walk down the dirt streets. Because it’s a hot, dry day, everyone’s out on the street. Everywhere we look, people are trying to earn some money on the side by selling fruit, grilled fish, second-hand clothes and shoes and what do you know, own-brand tissues from Belgian supermarket Colruyt, which seem to be omnipresent these days.
We meet with Mrs - Maman - Esther Fifi Ulabila, Fifi to her friends, in a small courtyard, a meeting place of one of the many churches in Kinshasa.She is the secretary of the “Comité d’Initiative des Mutuelles de Santé de Masina”. The district has been pondering the creation of a health insurance fund for many years but only took the leap when an NGO offered support, founding a Comité with nine members.
Because health care is so exceptionally expensive in Kinshasa, many people wait too long to visit a doctor, and in some cases they don’t go at all. Or they buy over-the-counter medicines in one of the many local “pharmacies”, which often sell junk. Or they turn to traditional or faith healers.
You can’t put a price tag on health
The Comité hopes to curb mortality in the district with the motto “La santé n’a pas de prix” [there’s no price tag on health]. But how do you do this in a culture where people mainly live in the here and now and where solidarity ends at the boundaries of a person’s extended family? In a culture where so many fraudsters have already established a health care fund only to make off with the funds they raised?
Fortunately, the Comité can rely on support from CGAT. CGAT provides technical support to health insurance funds and assists them with risk management. Founded by the Mutualités Chrétiennes, CGAT now also receives technical support from BRS.
Maman Fifi elaborates. She is very happy with the arrival of CGAT, a reliable and experienced partner. The Comité received extensive training on the principles and functioning of a health care fund. Together with CGAT, they are working on defining the “product” that the new health insurance fund will promote in Masina.
And we get to see first-hand how they do this: 23 focus groups of 15 residents each try to assess how often they seek medical assistance or in any event how often they think they do (there are no statistics available). They also define the priorities in terms of coverage (outpatient care and birth only, or also surgery and hospitalisation?), which health care institutions must be included in the offering, and how much they can spend. They also examine the income of the households that will join the fund. They do this by asking questions about the spending habits of these households. Two expenses stand out: communication (mobile phones) and beer.
In effect, this is an excellent example of product development.
Maman Fifi and the Comité are trying to come up with a cover that is eminently affordable in this context. They are also very ambitious: their goal is to have 5,000 members signed up six months after start-up. Here too, they intend to collaborate with CGAT to develop a persuasive campaign.