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Last Updated: Tuesday, 24 October 2006, 00:45 GMT 01:45 UK
Free healthcare for Comoros villages
By Daniel Dickinson
BBC News, Grande Comore

The rock-strewn village of Mnoungou, nestling on the slopes of Grande Comore's colossal active volcano, Mount Kathala, is taking part in an experiment to test a new form of health insurance, which could serve as a model for other poor countries.

Rukia and Jasmine
Rukia Said Mohammed says she might not have survived her pregnancy

Like most people in the Comoros islands, Mnoungou's 865 residents find it difficult to afford healthcare.

But under the new Village Social Security Scheme, the village, rather than the individual, pays for medical care and residents are reaping the benefits.

"During my pregnancy I had a lot of problems and had to go to the hospital many times," says Rukia Said Mohammed, playing with Jasmine, her five-month daughter.

Her personalised yellow membership card, which she displays proudly, gives her free access to a wide range of medical services.

She says without free medical care she might not be playing with her baby daughter today.

"For the birth of my first two children I had financial support from my husband but not this time. Without the village social security, I would not have gone to hospital and might have died."

Like most developing countries with weak infrastructure, the Comoros healthcare system has often failed to cater for the medical needs of its 812,000 people.

As a result, some urgent medical problems accidents and pregnancy and childbirth often lead to avoidable tragedies in the Comoros.

French connection

A new partnership between some Comorian communities and a French organisation, the International Centre for Development and Research (CIDR) aims to provide a health insurance policy.

Map of Comoros Islands
With some luck, ICDR Country director Alexis Bigeard says it could provide the impetus to set up village health insurance schemes in other African countries.

"I hope it will help the research action across Africa and mixing with some other schemes and research, we may find some other solutions appropriate to the local communities" Mr Bigeard said.

"We have to find specific solutions to specific communities in Africa for this issue."

Health insurance schemes are, of course, not new.

But it is difficult to find a model which works for the rich as well as the poor. Most often, the poor can rarely afford the individual insurance payments.

The Village Social Security Scheme has changed that, as it is the community rather than the individual which pays.

Expatriate aid

Like most Comoros villages, Mnoungou has a very strong social structure.

The community is able to collect significant amounts of money from all its inhabitants, money which is often sent from Comorian living overseas.

Children in Comoros
Most villagers cannot afford individual health insurance

The funds pay for village events and small projects.

The social security scheme harnesses these funds.

"There comes a point when most people do not use hospital services because they don't have the money," says Mohammed Rafiou who runs the scheme in Mnoungou.

"I realised there was a lot of money in our village, so I thought we could use some of it for health care. It's now the second year and the system is working well. All the villagers are happy," he says as he stamps new membership cards.

The social security scheme needs contributions of $7,000 a year to be sustainable.

For this amount, not every medical problem can be covered.

"'We cover the most urgent medical needs... problems which require hospitalisation... pregnancy and childbirth, accidents...but only in government health centres...not in private clinics," Mr Rafiou said.

It is an easy system for the villagers to use.

They just need to show their membership card at the health centre; and they don't have to hand over any money.

In Mnoungou, it would seem that a specific solution has been found, as villagers are being treated more quickly and the health of people generally is improving.

And as long as the community can continue to fund the scheme, then everyone will have access to free health care.

Country profile: Comoros
20 Jul 06 |  Country profiles
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08 Oct 06 |  Business

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