DETERMINANT DE L’ADHESION A LA COUVERTURE MALADIE DANS LE SECTEUR INFORMEL AU MALI : CAS DE LA COMMUNE RURALE DE M’PESSOBA

As part of the health coverage, Mali opted for mutual health insurance to cover the informal sector. To this end, the State subsidizes them by providing financial and technical support. To encourage membership, the state pays half the membership fee. However, the coverage remains low and was around 5% in 2015. To understand the reasons for this low coverage, we initiated this study. Thus, a quantitative cross-sectional study was conducted and a questionnaire on the individual characteristics of household heads was administered to 210 respondents. The Chi2 test and the logistic regression allowed the analysis, the significance level of the tests and the confidence intervals (CI) to be 5%. We have achieved the following results: the membership rate is 13.8%. In the bi-varied analysis, the associated variables are: age, having heard about the mutual, health expenses, participation in the meeting and decision-making as well as the satisfaction of the management of the mutual. Those retained in the final model of the regression were: the opinion on health expenditure OR = 2.9 (95% CI [1.3-4.3], p <0.01) and participation in the meeting OR = 0.1 (95% CI [0.02-0.3], p <0.001). hus, those who attend the meeting are 90% less likely to join the mutual, and those who find health expenses affordable are twice as likely to join. To deal with this paradox, we recommend that the managers of the mutual insurance company strengthen awareness by placing particular emphasis on the existence of co-financing, and develop partnerships with farmers' organizations in order to increase the membership rate.  Keywords: health mutual, informal sector, determinants, accession