On 3rd and 4th February 2025, Bujumbura (Burundi) hosted the fourth international conference on the deployment of health mutuals in Africa. Louvain Coopération and its partners were present. A look back at the challenges of access to healthcare for all and the recommendations arising from this major event.

Organised by several mutualist actors, including the International Association of Mutual Benefit Societies (AIM) and the MASMUTplatform, the international mutualist conference brought together 200 participants from 24 countries under the theme: "Objective: Universal Health Coverage and Social Protection in Africa – Relying on Mutuals as Key Pillars of the Social and Solidarity Economy."

Today, in most African countries, only a minority of the population benefits from any form of social protection. Existing health insurance covers a small portion (10 to 15%) of the population, namely civil servants, the military, teachers, and, in some cases, private-sector employees (such as in Burundi). The vast majority of the population works in the informal sector, for which no official health insurance currently exists. Health mutuals represent a key solution to bridge this gap.

However, their development faces several major obstacles, including an insufficient legal framework: while regulations exist, their implementation remains limited. Another challenge is the lack of institutional recognition, as mutuals are not fully integrated into national health strategies. Limited resources also threaten the viability of mutuals, as does the non-mandatory membership system, making it difficult to achieve financial sustainability.

In response to these challenges, the discussions at this international conference led to several strong recommendations. To ensure access to quality and affordable healthcare, the mutualist movement calls on policymakers and international decision-makers to:

1. Recognise mutual benefit societies alongside cooperatives in international resolutions on the social and solidarity economy.
2. Implement and strengthen legal frameworks recognising health mutuals and their specificities. These frameworks should be enforced through concrete measures to ensure the institutional, technical, financial, and operational viability of mutuals.
3. Establish and effectively implement mechanisms for mandatory membership in health coverage for the entire population, based on a progressive approach.
4. Organise and manage universal health coverage (UHC) through a delegated management system entrusted to mutuals by the state.

Burundi's Minister of National Solidarity, Imelde Sabushimike, reaffirmed the government's commitment to UHC, highlighting the central role of mutuals. Beyond being a simple gathering, the Bujumbura conference marked a decisive milestone for the African mutualist movement. It is now up to governments and international partners to translate these commitments into concrete actions.