Skip to main content

Table 1 Framework for organising data and analysis

From: An in-depth investigation of the causes of persistent low membership of community-based health insurance: a case study of the mutual health organisation of Dar Naïm, Mauritania

Areas of performance:

 1. Access to health care services

 2. Contribution to equitable health financing

 3. Impact on service delivery

 4. Protection of household assets

 5. Inclusiveness

 6. Empowerment of members.

Determinants of performance:

 1. Creation: the objectives formulated by each stakeholder and the process that led to the launching of the CHI scheme.

 2. Environmental profile: background information on socio-economic conditions, the health system, health service delivery and quality of services, and health financing.

 3. Preparedness: readiness of the national administrative, legal and financial system, of the health sector and of the target population to integrate community health insurance.

 4. Resource mobilisation describes design and implementation related to premium, co-payment and subsidies.

 5. Marketing and communication

 6. Financial management: the administrative functions of budgeting and bookkeeping.

 7. Financial viability: financial results and specific indicators measuring financial viability of CHI.

 8. Managing risks: strategies to manage adverse selection, over-consumption, provider’s prescription, and fraud.

 9. Financial protection: risk-spreading between healthy and sick, prepayment to reduce direct payment at the time of illness and measures to reduce the overall bill.

 10. Premium calculation: how were benefits’ package and premium calculated

 11. Benefits: the package of services, conditions for accessing benefits, evolution of the package over time.

 12. Membership: rules and regulations, membership statistics and reasons for affiliation and drop-out.

 13. Social inclusion: strategies and activities for inclusion of vulnerable groups.

 14. Utilisation: utilisation figures of members and non-members; health seeking behaviour.

 15. Provider payment: rules and management practices related to claims’ payment.

 16. Health care provision: health care providers, quality of care, relationship between CHI scheme and health care providers, strategies and action to influence provision of care.

 17. Stewardship: legislation, government involvement.

 18. Governance & decision-making: organisational structure, interactions within the scheme.

 19. Role table: support to get insights in interactions.

 20. Empowerment: ‘empowerment in action’ describes the practices of community participation within the MHO; ‘empowerment as a result’ explores whether the organisational structures of the MHO influence power relationships in matters of health and society.