Horizon 1 1 5 OS CH : Chapitres d'ouvrages scientifiques Paying for health : learning from international experience 63-90 AFRIQUE ASIE 2026 fdi:010097278 ENG 10.1017/9781009746274.004 https://www.documentation.ird.fr/hor/fdi:010097278 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2026-07/010097278.pdf Horizon (IRD) Chapter 1.2 assesses community-based health insurance. Community-based health insurance (CBHI) is a voluntary, self-organized approach to financing health care for groups of individuals in the absence of other forms of health care coverage. CBHI scheme members organize themselves; collect and pool their insurance premiums; and use them to purchase health services for members. Key learning includes that CBHI is not a miracle solution to affordable access to health care. - The very poor often do not enroll, and when they do they tend to use fewer health services. - Out-of-pocket (OOP) payments are not necessarily reduced. Low uptake, poor delivery of promised benefits and challenges around governance undermine the impact of CBHI. CBHI does not overcome broader issues such as a lack of financial resources. CBHI might serve as a transitionary mechanism towards UHC and offer some financial protection for the most vulnerable provided that - Policy-makers create a supportive political and economic environment - Social capital can be mobilized. - Schemes are institutionalized within the health sector. 056POLSAN