ACCEL Cote d'Ivoire
Taking stock of initiatives to expand access to Universal Health Coverage (CMU) for cocoa farmers in Côte d'Ivoire: Assessment and recommendations for the roadmap
In Côte d'Ivoire, the ILO's ACCEL Africa project piloted an innovative approach to extend Universal Health Coverage (CMU) to vulnerable cocoa farmers. Stakeholders from cooperatives, cocoa exporters and health centers who participated in the first phase of the pilot initiative provided feedback on access to CMU services in localities.
9 June 2023
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When families are exposed to shocks and disruptions, such as a illness or job loss, family incomes may be affected, influencing household decisions about the education of children. children and their early entry into the labor market. Access to social protection, including universal health coverage (CMU), protects families from some of these shocks and thus contributes decisively to the elimination of child labor worldwide.
In Côte d'Ivoire, only 6% of households were covered by social protection mechanisms in 2021, resulting in a large majority of the country's population being unprotected against risks, including work-related accidents or illnesses. The CMU set up by the government of Côte d'Ivoire is a solution for this large part of the population not covered by a social protection mechanism so that it can be insured against the risk of illness.
It is in this context that the ACCEL Africa project of the ILO, has established a partnership with the National Health Insurance Fund (CNAM), with a view to extending the CMU to the communities of cocoa farmers in Côte d'Ivoire. After a diagnostic analysis of the obstacles to access to CMU for cocoa producers, the ILO and the CNAM developed a plan to facilitate this access to CMU. The plan included the awareness raising of actors, the enrollment of producers, the distribution of insurance cards, the integration into the CMU care network of the health centers closest to the producers and the alternatives for the mode of payment of CMU contributions. The collaboration with the usual players in the cocoa supply chain, such as cooperatives and exporting companies, has been a transversal approach throughout the implementation of this plan.
The ACCEL Africa project and CNAM piloted the plan and received promising feedback throughout the various stages of the initiative, collecting responses from leaders and members of partner cooperatives, as well as health centers in sub- prefectures of Grand Zattry and M'Batto.
Specifically, an awareness campaign was created with the leaders of the eight (8) partner cooperatives, which made it possible to establish a joint implementation plan between the CNAM, the exporters, the cooperatives and ACCEL Africa. The partner cooperatives clarified their involvement and their contributions to the project. Focal points have been designated by each actor to facilitate communication. The director of a Grand Zattry cooperative testified positively: “We already knew the CMU, but here we were able to ask all the questions we wanted. »
After the first meeting with the managers of the partner cooperatives, a second awareness campaign was sent to the members of the cooperatives to explain to them the process of joining the CMU. Representatives of the CNAM were present on the ground during the campaign, which reinforced the reinforcement of the intervention.
After awareness-raising activities for the leaders and members of the partner cooperatives, the enrollment campaign was planned. This phase involves providing up-to-date information on cooperative members. Farmers belonging to cooperatives is a plus as it facilitates the process of distributing membership cards once enrollment is complete.
ACCEL Africa partners on the ground reported that several good practices emerged from this phase, such as strengthening communication channels with cooperatives and mobilizing witnesses to attest to the identity of farmers who did not have identity documents.
The preparations eventually bore fruit and an enrollment campaign to facilitate registration at the CMU followed by the distribution of the cards.
The CNAM prepared for the initiative by activating the health centers closest to the cooperatives and by sending a delegation of trainers to strengthen their capacities to welcome future policyholders. 1,815 cocoa farmers from eight cooperatives joined the CNAM, and nine community health centers were integrated into the network of CMU providers in the villages of Grand-Zattry and M'batto where the partner cooperatives had their members. The delivery of CMU insured cards was marked by strong words from a beneficiary: "we too are like civil servants; we have cards with which we can access health services at a lower cost"
While it is important to have access to social security, it is equally crucial to ensure that producers pay their financial contributions. To do this, ACCEL Africa partnered with cooperatives that helped their members contribute through mobile money. A leader of a cooperative in Grand Zattry explained: “We help members to pay their dues through Orange Money. They come to pay me in cash because they don't know how to do it.” The project has also partnered with cocoa exporters, such as OLAM International, to enable them to contribute financially on behalf of the vulnerable producers they work with.
However, despite this progress, access to CMU benefits presents difficulties for some insured persons. Holding a CMU card does not automatically give you access to CMU services. This is for example the case related to the waiting period and the fact of being late with your contributions. In addition, some technical problems remain in terms of access to services. This is the case with insurance card readers and the use of CMU in pharmacies. These problems can create frustration among the insured, as is the case of a beneficiary who is a member of a cooperative who benefited from reimbursement of the contributions: "Last time, I went to the village hospital to seek treatment, I am told that the devices do not work. So I informed my ADG to pass on the information”.
The monitoring of the pilot initiative by the stakeholders made it possible to capture these difficulties, to formulate recommendations for the obstacles to the adoption of UHC. These recommendations range from carrying out regular check-ups with activated health centers and private pharmacies to ensure that doctors have received their prescription codes and that all equipment is in working order, to setting up committees local and regional offices for monitoring access to CMU composed of cooperatives, the Ministry of Health and Public Hygiene and CMU, the Ministry of Employment and Social Protection, and the sub-prefectures for facilitate dialogue for effective resolution of local issues.
Despite these challenges, this initiative of the ILO's ACCEL Africa program nevertheless presents an innovative way to extend social security coverage in Côte d'Ivoire. This innovation manifests itself in two ways: first, by seeking to build on existing government institutions and programs that provide social security services; second, by working with private sector actors, particularly those who would benefit most from ensuring the well-being of their producers.
The initiative is being extended with the participation of 10 new cooperatives, which has facilitated the enrollment of 4,702 producers and the distribution of 4,235 new CMU insurance cards to cocoa producers in April 2023. Five exporters have expressed their interest in participating to the initiative, two of which (TONY'S CHOCOLONELY, BEYOND BEANS) have already solidified their commitment by signing partnerships with the CNAM to finance the contributions of certain producers.
Based on feedback from partners on the ground and recommendations to improve service delivery, the ILO will continue to contribute to the expansion of UHC in Côte d'Ivoire as one of the tools for elimination of child labour.
In Côte d'Ivoire, only 6% of households were covered by social protection mechanisms in 2021, resulting in a large majority of the country's population being unprotected against risks, including work-related accidents or illnesses. The CMU set up by the government of Côte d'Ivoire is a solution for this large part of the population not covered by a social protection mechanism so that it can be insured against the risk of illness.
It is in this context that the ACCEL Africa project of the ILO, has established a partnership with the National Health Insurance Fund (CNAM), with a view to extending the CMU to the communities of cocoa farmers in Côte d'Ivoire. After a diagnostic analysis of the obstacles to access to CMU for cocoa producers, the ILO and the CNAM developed a plan to facilitate this access to CMU. The plan included the awareness raising of actors, the enrollment of producers, the distribution of insurance cards, the integration into the CMU care network of the health centers closest to the producers and the alternatives for the mode of payment of CMU contributions. The collaboration with the usual players in the cocoa supply chain, such as cooperatives and exporting companies, has been a transversal approach throughout the implementation of this plan.
The ACCEL Africa project and CNAM piloted the plan and received promising feedback throughout the various stages of the initiative, collecting responses from leaders and members of partner cooperatives, as well as health centers in sub- prefectures of Grand Zattry and M'Batto.
Specifically, an awareness campaign was created with the leaders of the eight (8) partner cooperatives, which made it possible to establish a joint implementation plan between the CNAM, the exporters, the cooperatives and ACCEL Africa. The partner cooperatives clarified their involvement and their contributions to the project. Focal points have been designated by each actor to facilitate communication. The director of a Grand Zattry cooperative testified positively: “We already knew the CMU, but here we were able to ask all the questions we wanted. »
“We already knew the CMU, but here we were able to ask all the questions we wanted. » Cooperative Leader
After the first meeting with the managers of the partner cooperatives, a second awareness campaign was sent to the members of the cooperatives to explain to them the process of joining the CMU. Representatives of the CNAM were present on the ground during the campaign, which reinforced the reinforcement of the intervention.
After awareness-raising activities for the leaders and members of the partner cooperatives, the enrollment campaign was planned. This phase involves providing up-to-date information on cooperative members. Farmers belonging to cooperatives is a plus as it facilitates the process of distributing membership cards once enrollment is complete.
ACCEL Africa partners on the ground reported that several good practices emerged from this phase, such as strengthening communication channels with cooperatives and mobilizing witnesses to attest to the identity of farmers who did not have identity documents.
The preparations eventually bore fruit and an enrollment campaign to facilitate registration at the CMU followed by the distribution of the cards.
The CNAM prepared for the initiative by activating the health centers closest to the cooperatives and by sending a delegation of trainers to strengthen their capacities to welcome future policyholders. 1,815 cocoa farmers from eight cooperatives joined the CNAM, and nine community health centers were integrated into the network of CMU providers in the villages of Grand-Zattry and M'batto where the partner cooperatives had their members. The delivery of CMU insured cards was marked by strong words from a beneficiary: "we too are like civil servants; we have cards with which we can access health services at a lower cost"
"we too are like civil servants; we have cards with which we can access health services at a lower cost" Beneficiary
While it is important to have access to social security, it is equally crucial to ensure that producers pay their financial contributions. To do this, ACCEL Africa partnered with cooperatives that helped their members contribute through mobile money. A leader of a cooperative in Grand Zattry explained: “We help members to pay their dues through Orange Money. They come to pay me in cash because they don't know how to do it.” The project has also partnered with cocoa exporters, such as OLAM International, to enable them to contribute financially on behalf of the vulnerable producers they work with.
“We help members to pay their dues through Orange Money. They come to pay me in cash because they don't know how to do it.” Cooperative leader
However, despite this progress, access to CMU benefits presents difficulties for some insured persons. Holding a CMU card does not automatically give you access to CMU services. This is for example the case related to the waiting period and the fact of being late with your contributions. In addition, some technical problems remain in terms of access to services. This is the case with insurance card readers and the use of CMU in pharmacies. These problems can create frustration among the insured, as is the case of a beneficiary who is a member of a cooperative who benefited from reimbursement of the contributions: "Last time, I went to the village hospital to seek treatment, I am told that the devices do not work. So I informed my ADG to pass on the information”.
"Last time, I went to the village hospital to seek treatment, I am told that the devices do not work. So I informed my ADG to pass on the information”. Beneficiary
The monitoring of the pilot initiative by the stakeholders made it possible to capture these difficulties, to formulate recommendations for the obstacles to the adoption of UHC. These recommendations range from carrying out regular check-ups with activated health centers and private pharmacies to ensure that doctors have received their prescription codes and that all equipment is in working order, to setting up committees local and regional offices for monitoring access to CMU composed of cooperatives, the Ministry of Health and Public Hygiene and CMU, the Ministry of Employment and Social Protection, and the sub-prefectures for facilitate dialogue for effective resolution of local issues.
Despite these challenges, this initiative of the ILO's ACCEL Africa program nevertheless presents an innovative way to extend social security coverage in Côte d'Ivoire. This innovation manifests itself in two ways: first, by seeking to build on existing government institutions and programs that provide social security services; second, by working with private sector actors, particularly those who would benefit most from ensuring the well-being of their producers.
The initiative is being extended with the participation of 10 new cooperatives, which has facilitated the enrollment of 4,702 producers and the distribution of 4,235 new CMU insurance cards to cocoa producers in April 2023. Five exporters have expressed their interest in participating to the initiative, two of which (TONY'S CHOCOLONELY, BEYOND BEANS) have already solidified their commitment by signing partnerships with the CNAM to finance the contributions of certain producers.
Based on feedback from partners on the ground and recommendations to improve service delivery, the ILO will continue to contribute to the expansion of UHC in Côte d'Ivoire as one of the tools for elimination of child labour.