Our vision is that the mutualist movement develops everywhere
— Issa Sissouma, Executive Director of the UTM
More than two decades ago, the chief physician of the Center for Community Health in the rural community of Nongom-Souala in Mali noticed the center’s services were largely unused by the region’s over 10,000 inhabitants. Nongom-Souala is primarily home to agricultural workers in the cotton industry, who struggle to afford healthcare, especially in the winter after harvest season when they are short on cash. To remedy this, the center’s chief started Cotonniers de Nongon Souala (MUT-CO NONGON), a healthcare mutual that was the first of its kind in rural Mali.
The idea is simple: a mutual is a form of community insurance where members pay a regular fee with the understanding that the funds will help any member who falls ill. Membership fees are between 1,000 and 2,500 CFA francs a month (equivalent to $2 to $5) plus an annual fee of around 3,000 francs, depending on the mutual, and cover 70-80 percent of healthcare costs.
In the last 25 years, healthcare mutuals in Mali have grown exponentially as a mechanism for providing universal access to care. In 1998, the Malian government established the Union Technique de la Mutualité Malienne (Technical Union of Malian Mutuals), a federated structure for mutuals. Presently, it includes 115 mutuals of which 108 are exclusively health mutuals that together provide for 35,000 people.
Most health mutuals arise for reasons similar to MUT-CO NONGON: people living in poverty suffer disproportionately from health problems, which in turn exacerbate poverty through lost wages and the costs of care. Mutuals attempt to intervene in this cycle by improving poor people’s access to healthcare and being responsive to local needs. In Mali, health mutual members can afford to utilize twice the amount of health services as the national average.
Unlike private health insurance companies, health mutuals only serve one community and are run by their members. All members are part of a general assembly that elects the board of directors to make decisions. Mutuals often have no employees, ensuring all fees go to the membership. While corporate insurers prioritize profits, mutuals can put their members first. The rise of the mutualist movement in Mali has increased access to healthcare for workers in agricultural and informal industries, which represent 78 percent of the population. In 2010, the Malian government began co-funding 50 percent of mutual membership fees for these workers and continues to support mutuals through government grants. Mali remains the only country in Sub-Saharan Africa to have a legislative and regulatory framework for mutuals. Mutualists hope that eventually they will be able to provide access to healthcare for everyone in the agricultural and informal sectors, and they continue to advocate for Mali to establish a universal form of healthcare.
