MURIGA in Guinea: an experience of community health insurance focused on obstetric risks

Guinea is one of the poorest countries in the world, as is reflected in its health indicators (Eckert 2002). According to the Demographic and Health Survey III (DNS/Macro 2006), Guinea’s maternal mortality ratio is 980 for 100,000 live births, and it has a neonatal mortality rate of 39 for 1,000 live births. In 1997, the government of Guinea, in collaboration with UNICEF, set up a project to reduce maternal and neonatal mortality in the health district of Dabola. This project aimed both at improving the quality of services and at enhancing community involvement through the establishment of community health insurance schemes for safe motherhood (MURIGAs). Following an evaluation of this pilot project, the MURIGA approach was adopted as a national maternal mortality reduction strategy and has since been developed in 17 of Guinea’s 33 health districts. Today, members pay a contribution of between €0.9 and €1.8 per year, depending on the sub-prefecture, entitling them to access to care in the event of obstetric complications, including caesarean sections. The cost for a csection in the event of a complication for non-members is €15 to €20, not including under-the-table payments and other possible indirect costs. 1 Institute of Tropical Medicine (ITM Antwerp), Department of Public Health, Institute of Tropical Medicine, Nationalestraat, 155, 2000 Antwerp, Belgium. Email : [email protected] (correspondence should be addressed to this author). 2 Coordinator, National Safe Motherhood Programme (PNMSR Conakry). 3 Specialist in Maternal and Neo-natal Health (UNICEF Conakry). 4 Coordinator, ‘Dynamic Mutualiste’ NGO, (DYNAM Conakry). 5 Technical Adviser/Capacity-building Health Programmes and HIV/AIDS control/GTZ (PSS Mamou). 6 Institute of Tropical Medicine (ITM Antwerp).