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Community-Based Health Financing
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Background and Strategy

PHRplus, and previously PHR, has substantial experience with community-based health financing (CBHF) (also known as mutuelles, or mutual health organizations (MHOs)) in the sub-Saharan African context. Through providing technical assistance in Senegal, Ghana, Mali, Tanzania, and Zambia, the Project has learned much about what makes CBHF schemes successful or not. Such schemes are now the focus of much interest on the part of the international community and have been proposed as a key strategy to resolve the health care financing problems of the poor.

PHRplus is providing technical assistance to multiple CBHF schemes in Ghana, Senegal, four schemes in Mali, and one district in Tanzania. In addition, some small-scale activities will be conducted in Côte d'Ivoire, Cameroon, Democratic Republic of the Congo, and Zambia.


  • Ensuring that CBHF schemes promote access to and use of priority services, particularly maternal health, child health, and HIV/AIDS services
  • Promoting the sustainability of CBHF schemes
  • Securing quality of care via MHOs
  • Ensuring that CBHF schemes contribute to overall health sector financing objectives
  • Monitoring and evaluating CBHF schemes
  • Disseminating lessons learned from PHRplus activities on CBHF schemes at the local, national, and international level

Decentralization and Management Strengthening at the Local Level

In many instances, decentralization is a highly politicized process and frequently it is initiated outside of the health care sector. PHRplus experience demonstrates that there is frequently confusion around decentralization and that problems arise if actors do not understand the decentralized context and lack capacity to perform the new roles they must play. For example, local level health units are not accustomed to handling finances; unless new systems and training are provided to help them manage money in a decentralized system, financial mismanagement is likely to occur.

In countries that are pursuing decentralization policies, PHRplus commonly (i) works with a range of actors to develop consensus about the nature and scope of decentralization, (ii) assists governments at all levels to help clarify new roles within a decentralized system, and (iii) builds capacity to perform these roles. As decentralization takes very different forms in different countries, its consequences are by no means certain; thus, PHRplus also advocates for and provides support to the monitoring of decentralization processes.


  • Consensus building
  • Clarification of roles
  • Management strengthening at the local level
  • Monitoring decentralization

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