Assessing the Impact of a Community-Based Health Insurance Scheme on Surgical Service Utilisation in Kayes, Mali: A 2021 Analysis

Access to essential surgical care remains a critical challenge in sub-Saharan Africa, with financial barriers being a primary constraint. Community-based health insurance schemes have been promoted to improve healthcare access, but evidence of their specific impact on surgical service utilisation is limited. This study assessed the impact of a community-based health insurance scheme on the utilisation of surgical services in the Kayes region of Mali. Its primary objective was to compare surgical utilisation rates between insured and uninsured populations. A cross-sectional analytical study was conducted using a mixed-methods approach. Quantitative data on surgical procedures were extracted from district health facility records. Qualitative data were gathered through focus group discussions with community members and key informant interviews with healthcare providers and scheme administrators. Households enrolled in the insurance scheme demonstrated a significantly higher rate of surgical service utilisation. Insured individuals were 2.3 times more likely to undergo a recommended surgical procedure compared to uninsured individuals. Qualitative data indicated that the reduction of direct out-of-pocket costs was the predominant factor enabling access. The community-based health insurance scheme in Kayes positively influenced surgical service utilisation by mitigating financial barriers. The findings suggest such insurance models can be an effective component of strategies to improve access to essential surgical care in similar low-resource settings. Policymakers should consider strengthening and expanding community-based health insurance schemes, with attention to sustainable financing and inclusion of the poorest households. Further integration of surgical care into benefit packages and ongoing monitoring of quality and financial protection are advised. Community-based health insurance, surgical access, financial protection, health systems, Mali, universal health coverage This study provides empirical evidence on the role of community-based health insurance in improving surgical care utilisation, contributing to the discourse on health financing and surgical systems in low-resource contexts.