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Gesundheitssicherung im Kontext sozialer Differenzierung

Duration: 2004 - 2013

Project leader: Alexander Schulze

External partners: Novartis

Funding: Novarits Stiftung

Project description


Community-based health insurance funds are a new form of health assurance for Africa’s rural population. Established and fostered in the 1990s, the gradually enter the life of the groups. Although the number of these local insurances is increasing, they are hardly widespread in the African countries and are only able to reach a minority of the population. Even though community-based health insurance funds are structurally small-scale organisations, they cover less than 10% of the aspired population in their locally limited catchment area. The great majority of these voluntary, honorary lead health insurance funds consist of only a few hundred to two thousand insurants.

The health economically coined analysis of the causes, why community-based insurance funds cannot exhaust their potential so far, initially focuses on technical and organisational and financial aspects of health insurance funds and health services. Later on there also “social” factors such as the widespread poverty came in to focus. In this context, first comparative studies between households covered and uncovered by insurance funds have been accomplished, which especially focussed on socio-economic status, bus also analyzed socio-cultural factors. Up to now, there is a lack of analysis, which could help to understand and systematically bring together the significant factors of influence and the characteristics of insured and uninsured households.


Research question

The research in two rural areas of Mali falls into line with the comparative studies. Thereby the perspective of analysis was extended from socio-economic differences to socio-spatial, socio-cultural, socio-political elements and structures within the family. Because so far there are barely approved models, via which social differences in African societies can capaciously and systematically be specified in terms of the local lived-in world, a part of the research work is the construction of an operationalizable frame to analyse social differences. The aim is, not to carve out different types of households, which distinguish themselves through a certain kind of lifestyle, but to develop explanation patterns for the choice of the particular assurance strategies, including the membership in health insurance funds, on this basis.



The empirical research bases upon a mixture of methods. Beside 600 structured household interviews about lifestyle patterns and assurance strategies also semistructured group discussions between younger and older women and men, migrants and persons in charge of health insurance funds as well as single interviews with selected families about decision processes and forms of solidarity within the families were held


Publications& Lectures


Schulze, Alexander 2010: Krankenkassenmitgliedschaft im ländlichen Mali. Eine neue Form der Gesundheitssicherung im Kontext sozialer Differenzierung. In: Dilger, Hansjörg; Hadolt, Bernhard (Hrsg.): Medizin im Kontext: Krankheit und Gesundheit in einer vernetzten Welt. Frankfurt am Main; Peter Lang; S. 305-328.

Schulze, Alexander 2009: Gemeindebasierte Krankenkassen im ländlichen Mali und das Problem niedriger Versichertenzahlen. welche Bedeutung hat der soziale Kontext?. In: Wolf, Angelika; Niechzial, Michael; Nagel, Eckhard (Hrsg.): Krankenversicherung und soziale Sicherung in Afrika. Perspektiven aus Entwicklungszusammenarbeit und Wissenschaft. Münster; Lit (= Beiträge zur Afrikaforschung, 35).


Schulze, Alexander 2005: Gesundheitssicherung im Kontext sozialer Differenzierung in Westafrika. Gemeindebasierte Krankenkassen in Mali. Vortragsreihe „Soziale Sicherung und Krankenversicherungen in Afrika, Institut für Medizinmanagement und Gesundheitswissenschaft, Universität Bayreuth, 18.05.2005.

Schulze, Alexander 2007: Gemeindebasierte Krankenkassen im Kontext sozialer Differenzierung. Zur Charakterisierung von Mitgliedern und Nicht-Mitgliedern im ländlichen Mali. Jubiläumstagung der AG Medical Anthropology der DGV, Berlin, 29.09.2007.

Schulze, Alexander 2008: Was erklärt Mitgliedschaft in gemeindebasierten Krankenkassen? Methodische Herausforderungen bei der Untersuchung des „sozialen Kontexts“ im ländlichen Mali. SAI, Universität Heidelberg, 30.01.2008.

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