Formal pooling of health risks in sub-Saharan Africa: Reflections on the obstacles encountered

Over the past few years a number of institutional solutions to the pooling of health risks have been advanced in a great number of reform proposals for developing countries. The empirical arguments in favour of such recommendations have the full force of accumulated experience in countries that have long been industrialized. However, rural realities in Africa and Asia naturally have very little to do with past or present realities in western countries. Whereas the technical-cooperation and scientific community has relatively good knowledge of techniques, a number of recent experiences of the introduction of mutual benefit schemes in Africa seem to show that this approach is now enjoying some success. The low levels of membership in particular make it essential to tackle the problem fully. This article tries to identify the various possible explanations for this lack of enthusiasm in sub-Saharan Africa.