Paper short abstract:

This paper is about social protection mechanisms during crisis and examines two community-based health insurance schemes that are meant to enable participants to avail of health services in conflict-affected Democratic Republic of Congo.

Paper long abstract:

During the war in Democratic Republic of Congo, a number of humanitarian agencies provided free health services, yet even in those years most health care was organised in a cost-recovery way and clients had to pay for the consultations and medicines. In view of dire poverty, a number of organisations in these years have set up community-based health insurance systems, or Mutuelles de Santé (MUS). They have the dual objective of providing social protection to the poor and to enable the operation of the health services by creating its clientele.

This paper examines two schemes, in rural Katana and in semi-urban Uvira. Research concerned their everyday working, and their success in terms of participation and health service provision. The Katana mechanism has been gradually growing in membership, whereas the Uvira mechanism has been losing participants after an initial set-up period. The paper finds major explanations for this difference on the one hand in the substantial costs of the insurance and confusion among the population, and on the other on institutional factors such as the level of support extended to the mechanisms.

The paper raises questions about the durability of these mechanisms in the absence of a regulating state, unless there is a strongly organised alternative supporter of the scheme such as an international NGO. One of the conclusions of the paper is that the community-based - rather than citizen driven - nature of the mechanisms may stand in the way of building a constituency for social protection in conflict-affected DRC.