Ivory Coast sets up mobile enrollment for a health coverage program criticized over glitches

ABIDJAN, Ivory Coast — Health authorities in Ivory Coast launched mobile enrollment centers for the country’s universal health coverage program, which has been criticized since its 2019 inception over difficulties accessing benefits.

Ivory Coast is one of a handful countries in West Africa that offers a universal health program. But, five years in, less than half its citizens have enrolled. Known locally by its French acronym CMU, the program is meant to cover 70% of citizens’ health care costs for a monthly charge of 1,000 West African CFA francs, or about $1.65.

However, many participants who have managed to enroll have reported glitches, including that vouchers given at hospitals that are supposed to provide them with medicine are later not accepted at pharmacies — requiring patients to pay out of pocket.

The mobile enrollment centers being rolled out at markets and remote neighborhoods are meant to allow Ivorians to sign up for the program and provide them with cards on site so they can immediately start receiving care at hospitals, clinics, and pharmacies around the country.

From 2019 until this year, only 13 million people, or 40% of the population, were able to enroll.

The country’s Health Minister, Pierre Dimba, said the mobile centers are aimed at reaching people who have been unable to sign up for reasons including that they work long hours.

“We used the method which worked well when we did the COVID-19 vaccination, which was to go to these people in the markets, in remote neighborhoods, to get them signed up,” he said.

Resident Bruno Agnissan already has a CMU card, but he came to an Abidjan mobile enrollment center in search of information about how to successfully use it.

He said that while his son was being treated for malaria at a hospital, the facility ran out of medicine. He was given a voucher and told find the medicine at a local pharmacy.

“When we went to the pharmacy and I presented the voucher, the pharmacy said that no, this is only for civil servants, that it won’t work for us individuals,” Agnissan said. "I went to all the pharmacies, and it didn’t work.”

Ultimately, he had to pay for the medicine out of his own pocket, he said.

Samuel Touffet, another local resident who came to the mobile center to get updated on coverage under the program, echoed Agnissan’s concerns.

“There are so many pharmacies where if we go with the card, it doesn’t work. So we want to know, where are the pharmacies where we can go and use the card?” he said. “Also, when we go to the hospital with the card, they say it doesn’t work. So we don’t know what this card is even worth.”

Resident Martin Abou, who came to enroll himself and his family for the first time, was hopeful. “You never know. We don’t know what tomorrow has in store for us,” he said.

Dimba, the health minister, said that he hoped the program becomes a basic insurance that covers every Ivorian citizen, with private insurance used only as a supplement.

He added that he the goal was to have 20 million Ivorians enrolled by the end of the year.