Mutual Health Research Articles

Characteristics of patients requesting an abortion beyond 14 weeks of gestation: retrospective study in Brussels

ObjectivesThe debate over extending the legal time limit for abortion in Belgium has intensified in recent years. Healthcare providers must refer patients seeking abortion beyond the legal deadline to other countries, such as the Netherlands, where the time limits are more permissive. In light of this situation, we analyzed the demographic and social characteristics of patients requesting abortion after 14 weeks of gestation and compared them with those seeking the procedure within the legal limits. Study DesignThis retrospective study examines the sociodemographic characteristics of individuals requesting abortion at City Planning Brussels between first January 2022 and 30 March 2023. We employed logistic regression to identify predictive factors for late abortion. ResultsWe analyzed 627 abortion requests, with 593 occurring before 14 weeks and 34 after 14 weeks. Patients seeking abortion due to precarity or rape had a higher risk of presenting beyond the legal time limit (OR 3.64, p = 0.001, and OR 3.96, p = 0.009, respectively). Factors that appeared to reduce this risk included requests for abortion based on personal reasons (lack of desire for a child) and being covered by mutual health insurance (OR 0.22, p < 0.001, and OR 0.25, p 0.001). ConclusionManagement of late abortion in Belgium is difficult due to law’s restriction. Our data indicate that the circumstances resulting in late abortion requests are often complex, frequently involving factors such as financial difficulties and precarity. A law modification is necessary to provide uniform and effective care for these patients.

Assessment of the Viability of Community-Based Health Insurance Schemes in the Ziguinchor Department from 2016 to 2018 in the Context of Universal Health Coverage (Senegal)

&amp;lt;i&amp;gt;Introduction&amp;lt;/i&amp;gt;: This study examines the viability of community-based health insurance schemes in the Ziguinchor department of Senegal from 2016 to 2018, within the context of universal health coverage. Health insurance schemes have emerged as a promising solution to extend social health protection to informal sector workers and rural populations. However, despite political support, these structures face persistent challenges in terms of enrollment, member retention, and management. The study aims to assess the viability of these schemes, as well as the perceptions of various stakeholders on mutual health insurance. &amp;lt;i&amp;gt;Methodology&amp;lt;/i&amp;gt;: The study adopted a mixed approach, combining quantitative and qualitative methods, based on the theoretical framework developed with the support of the International Labor Office (ILO). This framework evaluates the viability of health insurance schemes according to four dimensions: institutional, technical, functional, and financial/economic. A questionnaire with 87 questions was used to collect quantitative data on these aspects from the seven health insurance schemes in the Ziguinchor department. For the qualitative component, focus groups and individual interviews were conducted with various actors, including beneficiaries, non-beneficiaries, community leaders, scheme managers, and healthcare providers. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The study&amp;apos;s findings reveal a complex situation for the health insurance schemes in the Ziguinchor department. Institutionally, the schemes have a solid foundation with legal status, internal regulations, and affiliation to a departmental union. Technically, membership is voluntary and family-based, with control mechanisms in place, although their effectiveness is limited. Functional viability shows positive signs with a membership growth rate of 20.18%, but the overall penetration rate remains low at 16.99%, and the premium collection rate is very low, averaging 26.78%. The financial situation is particularly of concern: no scheme can meet its short or long-term debts, and the average claims ratio is excessively high at 282%. As for stakeholder perceptions, they are mixed: while the schemes are generally considered beneficial, significant practical difficulties are identified, including lack of information, funding problems, and procedural complexity. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: The study highlights the complexity of the role of health insurance schemes in the quest for universal health coverage. Despite undeniable strengths, the schemes face considerable challenges in terms of functional and financial viability. Corrective measures are necessary, including strengthening management capacities, innovating premium collection methods, and improving communication. An evolution of the model is also suggested, potentially towards greater integration into a national social protection system or the development of innovative public-private partnerships.

A pilot study of a joint outdoor exercise program for dog owners and dogs

Increasing levels of physical inactivity is a global burden for mankind and is also an emerging problem in companion dogs. In both humans and dogs, insufficient physical activity is associated with increased risk for noncommunicable diseases and impaired quality of life (QoL). The aim of the current pilot study was to evaluate effects of a joint outdoor exercise program for dog owners (n = 22) and dogs (n = 22) with focus on QoL and body measurements. Results indicate that an eight-week exercise intervention alone, with a target distance of at least 2 km twice a week, may be sufficient to significantly increase self-reported QoL and acceptance of bodily appearance in dog owners despite no reductions in body measurements. In dogs, a significantly reduced body condition score (BCS) was registered, despite no considerable changes in feeding. The increased owner motivation for continued joint exercise suggests potential for lifestyle changes, which could be investigated in future studies including control groups and long-term follow-ups. The importance of the human-animal bond as a success factor for increased mutual physical activity and health benefits in both dog owners and dogs is recommended to be studied in a more in-depth manner.

Challenges and strategies in the surgical management of traumatic spinal cord injuries in the Democratic Republic of the Congo

BackgroundSignificant progress has been made in the management of traumatic spinal cord injuries. However, deep disparities persist in developing countries. This work aims to describe the different challenges in the surgical management of traumatic spinal cord injuries at the Kinshasa University Teaching Hospital and some strategies implemented to overcome them. MethodsThis is a cross-sectional study of 105 patients from January 2016 to June 2023. The variables of interest included: gender, age, cause, levels of lesion, hospital admission modalities, time to admission, time to surgery, AIS score at admission and on discharge, treatment, pre, peri- and post-operative complications and outcome. ResultsWe admitted 105 patients. Only 16 % of them were taken to hospital in an ambulance. The average admission time was 49.9 ± 81.79 days. Seventy-two patients (68.6 %) were operated. The average time to surgery was 62.43 ± 85.20 days. No patient was stabilized at the trauma site. Osteosynthesis was performed with appropriate implants in 63.2 % and with improvised elements in 26.8 %. Four patients were operated without an image intensifier. Short-segmental fixation was performed in 8 patients. Twenty-one patients developed pressure ulcers. At discharge, 24 patients recovered their neurological function. Neurological status remained stationary in 43 patients. Five patients died. Seventeen patients went to rehabilitation center. There was no significant difference between the improvised strategies implemented and conventional procedures on functional recovery upon discharge from hospital or rehabilitation centre (p-value : 0.838 and 0.468 respectively). ConclusionOur establishment faces many challenges in TSCI surgery: lack of pre-hospital emergency services and mutual health insurance, delay in admission, lack of surgical implants and image intensifier, the poverty of the population. Some strategies have been implemented to overcome some of them.

​​Invoking Senghor​: Universal Healthcare Coverage and the Place of Culture in Senegal

Senegal introduced Couverture Maladie Universelle (CMU), its version of universal health coverage (UHC), in 2013, basing it on the establishment of mutual health insurance. Mutual health organisations (mutuelles de santé) manage the pooling of funds, including member enrolment fees and government subsidies; in an effort to extend the reach of UHC, the Senegalese cultural sector created a mutuelle of its own. As part of ethnographic fieldwork focused on CMU, I attended a ceremony at the Grand Théâtre National de Dakar on the occasion of this mutuelle receiving a large cheque from the government. In this Field Note I examine the centring of Senegalese culture during this event to reflect on the national project of development itself. The event’s celebration of the arts sector coupled with its emphasis on mutualism and solidarity invoked Senegal’s post-colonial developmentalist visions and aspirations that were motivated by négritude and African socialism under its first president, Léopold Sédar Senghor. Engaging with renewed calls for African values and morality to be put at the centre of development, I argue that ambitious endeavours like CMU present such an attempt and help buoy it, but that, in the context of continued healthcare underfunding, one-off gifts like that presented during the ceremony are unsustainable.

Supporting each other: Older adults’ experiences empowering food security and social inclusion in rural and food desert communities

Older adults vulnerable to food insecurity are at risk of poor psychological and physical health. Poor public infrastructure or proximity to food sources can exacerbate risk of food insecurity. Reduced statutory services for social care has heightened the responsibility on third sector organisations and community-led volunteering, essential to supporting healthy ageing in place and reducing the inequalities of ageing. The aim of this qualitative study was to explore how older adults' volunteering with a third sector organisation focused on food access supports food security and builds social capital for socially or economically marginalised older adults within rural and food desert communities. The study aims to bridge the knowledge gap of how volunteering in vulnerable geographies affects food insecurity and community. Semi-structured interviews were conducted with seven older (55+) volunteer ‘meal makers’ working with the third sector organisation Food Train and its ‘Meal Makers’ project. Interview recordings were transcribed and thematically analysed. Ecomap methodology was used to illustrate the lived experiences of older adult volunteers as told through the interviews. Two themes were identified by Thematic Analysis: (1) Networks, connectedness, and exposure to social capital, and (2) Supplementary support. This study finds that older adult volunteers are well placed within community interventions supporting food insecure older adults in rural or food desert communities. Ecomaps demonstrated that high social capital volunteers can mediate food access barriers and highlighted points of local knowledge and social connection. Volunteer engagement provides opportunities for food secure older adults to share local knowledge and build networks of food support and social inclusion for food insecure older adults. Older age volunteering should be advocated as a multi-faceted intervention promoting mutual health and wellbeing in volunteer and beneficiary.

Factors Associated with Membership in a Mutual Health Insurance Fund in the Thiès Region (Senegal) in 2023: Article

 Introduction : Mutual health insurance constitutes a micro-insurance system which facilitates access to care by avoiding direct payment. They represent one of the pillars of our Universal Health Coverage. After years of existence and despite political commitment, community support for mutual health insurance remains low until now. The objective of our work was to study the factors linked to the membership of mutual health insurance companies in the Thiès region and to propose solutions.  Methodology : The study was cross-sectional, descriptive and analytical. It was carried out among a sample of 1,300 people, residing in the Thiès region for at least 6 months, chosen following a three-stage cluster survey. A questionnaire was used to collect data related to predisposing, facilitating and health system factors. These data were entered and analyzed using SPSS version 21 software. The significance value was P &lt; 0.05. The Odds ratio was used to measure the strength of the link.  Results : The average age is 42 years and among the people surveyed 75.3% lived in an urban area, 84.5% claimed to know mutual insurance companies. The number of dependent children among the people surveyed was 9 and 90% had an income-generating activity, married people were 82.9% and 78.2% were educated. The mutual penetration rate was 69.3%. The analysis showed that membership in mutual health insurance was significantly influenced by the area of residence with P &lt; 0.001 [OR: 2.0; CI:1.4-2.8], by age group with P &lt; 0.001[OR:1.4; CI:1.1-2.0], by income-generating activity with P &lt; 0.001 [OR:2.1; CI:1.1-4.1], by knowledge of a mutual with P &lt; 0.001 [OR:81.6; CI: 42.2-157] and education with P &lt; 0.001 [OR: 1.9; CI: 1.3-2.6]. Membership was also associated with marital status and the number of children in care with P &lt; 0.001 and P &lt; 0.002 respectively.  Conclusion : This study made it possible to evaluate the penetration rate of mutual health insurance in the Thiès region in 2023, but also to identify the factors associated with membership in a mutual health insurance. Strengthening communication and targeted awareness and improving the level of knowledge of the populations will help to boost the level of support of the populations of the Thiès region.

Impact of Land Use Consolidation on Maize Growers' Welfare in Gatsibo District, Rwanda (2012-2015)

This research delved into the transformative role of land use consolidation (LUC) in enhancing the well-being of maize growers within Gatsibo District, Rwanda, spanning from 2012 to 2015. Employing a descriptive and analytical approach, comprehensive data were gathered from primary sources, drawing from documentation, literature, and library resources. Analysis was conducted utilizing statistical tools like SPSS and Excel, resulting in insightful revelations. The study indicated that a substantial majority of respondents (95%) practiced intercropping maize with other crops using traditional methods. However, postLUC implementation, there was a marked shift as maize growers transitioned to exclusive maize cultivation on a larger scale, significantly boosting maize production. Notably, 85% of respondents ceased the use of intercropping methods, highlighting the pivotal role of LUC in optimizing maize yield and profitability. Moreover, a significant portion (78%) of respondents reported a considerable increase in maize production ranging from 25% to 75%, elucidating the profound impact of LUC on enhancing economic conditions. This positive shift was reflected in increased monthly earnings and savings, empowering respondents to elevate their socioeconomic status. Consequently, there was a notable surge in various improvements, including enhanced access to healthcare through Mutual Health Insurance, increased expenditures on essentials like clothing, education, household amenities, and the engagement of additional laborers. While LUC brought about substantial improvements, respondents encountered challenges such as inadequate organic manure, adverse weather conditions, low market prices for products, and limited markets for maize. To address these challenges, suggestions were made, including the expansion of communal cowsheds to bolster organic manure production, the establishment of advocacy groups within cooperatives, and the implementation of efficient watering systems to support year-round cultivation, thereby ensuring the sustainability of maize farming. In summation, the implementation of LUC significantly transformed the livelihoods of maize growers in Gatsibo District. Despite encountering challenges, the tangible benefits in terms of increased production, improved economic conditions, and avenues for further enhancements underscore the pivotal role of LUC in fostering agricultural prosperity within the region. Keywords: Land Use Consolidation, Maize growers and Welfare, Crops, Maize production, watering system.

Self-Care and Mutual Care in the Context of Person Centred Medicine

Introduction: The Geneva Declaration emerging from the 13th Geneva Conference on Person-Centred Medicine dealt with self-care, inter-care, and well-being during COVID-19 pandemic times. For the first time since the inception of the Geneva Conferences, the main theme involved self-care and inter-care. Not only these important healthcare strategies were innovative but also their specific relevance to person-centred care was implicitly assumed but had not been pointedly articulated. There has been significant literature available on self-care and only recently on inter-care, a concept sometimes referred to as mutual care. Objectives: The main objective of this paper is to examine systematically the place of self-care and mutual care within the framework of person-centred medicine (PCM) and thus help substantiate academically the main theme of the 2021 Geneva Declaration from the International College of Person-Centred Medicine. Methodology: The main approach involved an exploratory review of the literature aimed at clarifying the extent to which self-care and mutual care are related to the core concepts and to the key principles of PCM. Results: The relationship of the self-care and mutual care health strategies to the core concepts and key principles of PCM is tabularly appraised. It was found that both health strategies were related to the three core concepts of PCM and to virtually all key principles of PCM, except the holistic framework. Conclusions: Self-care and mutual care are related to and substantiated by the core concepts and key principles of PCM. The value of these findings could be extended through the identification and analyses of best practices and the performance of systematic research studies.

Mapping and analysis of health financing in South Kivu province (DRC)

In South-Kivu, the health system is underfunded due to numerous constraints. Several initiatives have been tested but are insufficient for increasing and sustaining health financing. Analyze the health financing system in South-Kivu, through a mapping as well as quantitative and qualitative analysis of health financing mechanisms. The provincial health financing system is fragmented, with poorly coordinated mechanisms and interventions, leading to duplication of health system strengthening activities in addition to the absence of a mechanism for pooling external funding flows. Costs recovery (i.e. user fees) and external supports are the most widely used schemes while the government hardly contributes to the financing of the provincial health system. Mutual health insurance is supposed to improve access to health care, but its coverage is still extremely low. Results-Based Financing and free health care programs, fully financed by external donors, are irregular and insufficiently sustainable. It would be critical to implement a strategic purchasing model that is anchored in local institutions, owned by all stakeholders, and integrating all existing financing mechanisms, which could be supported by a common fund supporting the provincial health system. The “Single Contract” initiative developed to harmonize, pool, and sustain external programs, could be a good basis in this respect. This would involve strengthening policy dialogue, developing an investment case to support resource mobilization and implementing a joint monitoring and evaluation platform for disbursements led by the provincial health authorities.

Mandatory membership of community-based mutual health insurance in Senegal: A national survey.

With the low adherence to voluntary mutual health insurance, Senegal's policymakers have sought to understand the feasibility of compulsory health insurance membership. This study aims to measure the acceptability of mandatory membership in community-based mutual health insurance (CBHI) and to understand its possible administrative modalities. The study consists of a national survey among a representative population sample selected by marginal quotas. The survey was conducted in 2022 over the phone, with a random composition method involving 914 people. The questionnaire measured the socio-economic characteristics of households, their level of acceptability concerning voluntary and compulsory membership, and their level of confidence in CBHIs and the health system. Respondents preferred voluntary (86%) over mandatory (70%) membership of a CBHI. The gap between voluntary and compulsory membership scores was smaller among women (p = 0.040), people under 35 (p = 0.033), and people with no health coverage (p = 0.011). Voluntary or compulsory membership was correlated (p = 0.000) to trust in current CBHIs and health systems. Lack of trust in the CBHI management has been more disadvantageous for acceptance of the mandatory than the voluntary membership. No particular preference emerged as the preferred administrative channel (e.g. death certificate, identity card, etc.) to enforce the mandatory option. The results confirmed the well-known challenges of building universal health coverage based on CBHIs-a poorly appreciated model whose low performance reduces the acceptability of populations to adhere to it, whether voluntary or mandatory. Suppose Senegal persists in its health insurance approach. In that case, it will be essential to strengthen the performance and funding of CBHIs, and to gain population trust to enable a mandatory or more systemic membership.

Making health insurance responsive to citizens: the management of members’ complaints by mutual health organisations in Kinshasa, Democratic Republic of Congo

IntroductionIn moving towards universal health coverage, a number of low-income and middle-income countries have adopted community-based health insurance (CBHI) as a means to reduce both the inequity in healthcare access...

A Study on National Pension Scheme in India with Special Reference to Karnataka

The paper reviewed the National Health Insurance scheme and accessed the possibility of a single premium for decade. The entire paper had its base of a single premium for a decade that is feasible enough to sustain the scheme, to identify alternative means of generating income to sustain the Kassena Nankan District Mutual Health Scheme and to assess the perception of registered and potential clients on the NHIS. The research design employed was statistical survey and both qualitative and quantitative data were collected from a sample of 100 respondents. The research study has its justification from the current government’s intention to implement a single premium system for the NHIS. The research findings emphasised the inclusion of age distribution as key variable to avoid all ages

A STUDY ON LIC SCHEMES WITH REFERENCE TO CHILDREN AND WOMEN

Indian financial system is highly influenced by the banking and insurance sector which attracts a flow of savings and investments to the country. The Insurance sector in India is one of the growing sectors of the economy. The insurance sector, along with other elements of marketing, as well as financial infrastructure, have been touched and influenced by the process of liberalization and globalization in India. The customer is the king of the market. Life Insurance Company(LIC) deals in Intangible products, such as Insurance plans, Pension Plans, Unit Linked Plans, Micro Insurance Plans, Withdrawn Plans and, Health Plans. The process of insurance has evolved to safeguard the interests of people from uncertainty by providing certainty of payment at a given contingency. Issuing insurance policies at affordable rates helps to protect the capital of the people by investing funds into government securities. It provides customized insurance solutions based on their unique financial needs and risk profile, as well as assistance in resolving them. LIC is an insurance firm headquartered in Mumbai with 8 zone offices and 101 divisional offices. LIC provides mutual funds, health insurance, and investment management services in addition to life insurance. LIC is India’s largest firm, with 2048 completely computerized branches, 8 zonal offices, 113 divisional offices, 1381 satellite offices, and corporate offices spread around the country. In various Indian cities and towns, the country is divided into 54 customer zones and 25 service centers. For selling life insurance to the general public, LIC has 1,337,064 individual agents, 242 corporate agents, 89 referral agents, 98 brokers, and 42 banks. LIC aims to deploy the funds to the best advantage of the investors and the community as well. This research paper attempts to study the various schemes for a child and women, to know the factors influencing the choice of investors in choosing LIC Policy, and to analyze the performance of LIC by knowing customers' opinions.

Between voluntarism and compulsion: Membership in mutual health insurance societies in Swedish manufacturing, c. 1900

AbstractMembership in mutual health insurance societies spread among industrial workers in the late nineteenth century. We study determinants of such membership among male workers in Swedish manufacturing by using matched employer–employee data from three industries covering all workers (i.e. members and non‐members, N &gt; 12 000) and firms around 1900. We find remarkably high rates of membership overall, and especially among married workers. The association between marital status and health insurance suggests that selection into health insurance societies was ‘propitious’ rather than ‘adverse’. Many workers became members well before the age of 40 years, when their health began to deteriorate, and this coincided with the average age of first marriage for men, occurring in their late twenties. Being married and having membership was more marked in firms with voluntary membership and was important for the viability of the mix of voluntary and compulsory health insurance societies emerging in Nordic countries around 1900. Findings support the idea that health insurance can attract high levels of membership under voluntary schemes and suggest why it took so long before statutory health insurance covering sickness absence and workplace accidents was introduced in Sweden.

Levelling the playing field for the international migration of nurses: the India English Language Programme

BackgroundThis article presents evaluation findings of the India English Language Programme, an innovative programme aimed at providing Indian nurses with an opportunity to participate in an ethical and mutually beneficial learning programme aimed at supporting migration into the United Kingdom’s National Health Service (NHS). The programme provided 249 Indian nurses wishing to migrate to the NHS on an ‘earn, learn, and return’ basis with funding to support English language learning and accreditation sufficient to apply for Nursing and Midwifery Council (NMC) registration. The Programme provided English language training and pastoral support to candidates, in addition to the availability of remedial training and examination entry for those not meeting NMC proficiency requirements on their first attempt.MethodsDescriptive statistical analysis of programme examination results and cost-effectiveness analysis is presented to demonstrate programme outputs and outcomes. Descriptive economic analysis of programme costings is presented alongside programme results to investigate the value-for-money provided by this programme.ResultsA total of 89 nurses were successful in meeting NMC proficiency requirements, representing a pass rate of 40%. Those undertaking OET training and examination(s) were more successful, compared to those undertaking British Council provision, with over half of candidates passing at the required level. This equates to an overall programme cost-per-pass of £4139 and represents a model to support health worker migration, in line with WHO guidelines, delivering individual learning and development, mutual health system gain, and value-for-money.ConclusionsTaking place during the coronavirus pandemic, the programme evidences the effective delivery of online English language training to support health worker migration during a highly disruptive period for global health. This programme demonstrates an ethical and mutually beneficial pathway for English language improvement amongst internationally educated nurses to facilitate migration to and global health learning in the NHS. It provides a template through which healthcare leaders and nurse educators, working in policy and practice environments in the NHS and other English-speaking countries, can design future ethical health worker migration and training programmes to strengthen the global healthcare workforce.

The Benefit of Mindfulness Meditation

Unlike past psychological studies, which mainly concerned experimental ones such as behavior and nervous system, current research involves more traits related to attention and awareness. Hence, thanks to the growing concern for people’s mental health in modern society, the concept, “mindfulness” has gained ever-increasing impotence naturally as it could cultivate my awareness and benefit my both mental and mutual health.

Study of the viability of community-based mutual health insurances in the Department of Vélingara in 2019 in Senegal

Study of the viability of community-based mutual health insurances in the Department of Vélingara in 2019 in Senegal

Dental Bite-Sized Bits: A Module for Teaching Common Oral Health Conditions to Multidisciplinary Students.

The Surgeon General's report in the year 2000 highlighted the association between chronic diseases and oral health infections. Current healthcare education programs, regrettably, report only 1 to 3h of oral health instruction within curricula. In the years 2020-2022, as part of their respective oral health curricula, 278 first-year physician assistant and 12 pre-clinical second-year pharmacy students were invited to participate in a voluntary survey examining the effectiveness of animated succinct, online video-based oral health units. Among all student responses for the post-use survey, respondents "strongly agreed" or "agreed" that learning objectives of the unit(s) were achieved after reviewing the videos. Of the participants, 97% "strongly agreed" or "agreed" that the videos helped them understand information of which they had no prior knowledge. Similarly, 98% "strongly agreed" or "agreed" the information was appropriate for their level of knowledge. Most students, 93%, "strongly agreed" or "agreed" the exercise was a valuable learning experience. Regarding the importance of future interprofessional collaboration pertaining to a mutual patient's oral health, 95% of participants "strongly agreed" or "agreed" that they would be likely to collaborate. This study demonstrates the importance of oral health as a critical area of focus in healthcare education. The study also confirms the hypothesis that Dental Bite-Sized Bits units deliver engaging, valuable oral health education for preclinical healthcare learners, incorporating interprofessional perspectives from the disciplines of dental, pharmacy, and physician assistant.

Patronage, partnership, voluntarism: Community-based health insurance and the improvisation of universal health coverage in Senegal.

The turn towards Universal Health Coverage (UHC) in the past decade raises the question of the role of the state, following years of state withdrawal and a fragmented approach to public health. Senegal introduced its version of UHC, Couverture Maladie Universelle (CMU) in 2013 and this paper explores early efforts to fund it through the establishment of community-based health insurance (CBHI). The paper draws on ethnographic research at mutual health organisations, or mutuelles de santé as they are commonly referred to in francophone countries, which manage CBHI. The research was carried out as part of broader doctoral fieldwork on poverty and social protection in the capital, Dakar, in 2017-18. Responding to recent calls for the move away from the voluntary nature of CBHI with government subsidies and the professionalisation of management, this paper considers the financial strain that mutuelles were under. By drawing on the concept of 'improvisation' as it has come to be employed in recent ethnographies of health infrastructure in contexts of scarcity, the paper attends to the ways in which mutuelles and the voluntary workers that run them sought alternative forms of support, with a particular focus on patronage and partnership. I argue that what might appear to be very minimal gestures of support and material investment serve to maintain a sense of hope and potential in CMU, one however that is fragile and potentially unsustainable.