[Mutual insurances in Africa: Issues and perspectives]

From the end of the 1970s, the promotion of the community and the participation of populations in the health system reinforced the idea that mutual health insurance was a potentially major player in the extension of coverage against health risks. But the history of mutuality in Africa was quickly strewn with pitfalls. The structural adjustment plans and the increase in the financial contribution of users under the impetus of the Bamako initiative put a stop to the spirit of community mutual insurances. Today, mutual insurances are once again at the heart of international and national initiatives with the promotion of the (UHC) Universal Health Coverage. But they must overcome their historical shortcomings through professionalization and compulsory membership. This movement seems to be underway, while at the same time facing the challenge of preserving the place of communities in health systems, a founding principle of the mutualist movement.