In recent years, community health insurance (CHI) has emerged as a possible means of: (1) improving access to health care among the poor; and (2) protecting the poor from indebtedness and impoverishment resulting from medical expenditures. The World
Health Report 2000, for example, noted that prepayment schemes represent the most effective way to protect people from the costs of health care, and called for investigation into mechanisms to bring the poor into such schemes (World Health Organisation 2000).

Various other terms are used in reference to community health insurance, including: ‘micro health insurance’ [Dror et al 1999], ‘local health insurance’ [Criel 2000] and ‘mutuelles’ [Atim C 2001]. We define CHI (along the same lines as [Atim 1998]) as “any not-for-profit insurance scheme that is aimed primarily at the informal sector and formed on the basis of a collective pooling of health risks, and in which the members participate
in its management.” CHI schemes involve prepayment and the pooling of resources to cover the costs of health-related events.

Community health insurance is generally targeted at low-income populations, and the nature of the ‘communities’ around which they have evolved is quite diverse: from people living in the same town or district, to members of a work cooperative or micro-finance groups. Often, the schemes are initiated by a hospital, and targeted at residents of the surrounding area. As opposed to social health insurance, membership is almost always voluntary rather than mandatory.