Abstract
Background: Universal health coverage (UHC) is now high up the international agenda. There are still major needs to be met in West Africa, particularly in Mali, where providing health care for the poorest remains a big challenge. The majority of the region’s countries are currently seeking to define the content of their compulsory, contribution-based medical insurance system. However, very few countries apart from Mali have decided to, in parallel, develop a solution for poorest that is not based on contributions.Methods: This qualitative research article examines the historical process that has permitted the emergence of this ground-breaking public policy.Results: The research shows that the process has been very long, chaotic and sometimes suspended for long periods. One of the biggest challenges has been that of intersectoriality and the social construction of the groups to be targeted by this public policy (the poorest), as institutional tensions have evolved in accordance with the political issues linked to social protection. Eventually, the medical assistance scheme for the poorest (RAMED) saw the light of day in 2011, funded entirely by the government.Conclusions: Its emergence would appear to be attributable not so much to any new concern for the poorest in society but rather to a desire to give the social protection policy engaged in a guarantee of universality. The RAMED nonetheless remains an innovation within French-speaking West Africa.
Migrants’ Access to Social Protection in Ireland
