Evidence Base
The Science Behind
Community Health Insurance
Community-based health insurance is not experimental. Decades of peer-reviewed research across four continents proves it works — when designed with rigor, governed locally, and integrated with national systems.
What the Evidence Shows
Global Coverage Gap
4.5 billion people still lack essential health coverage.
Despite decades of global commitments, the majority of humanity has no reliable access to essential health services. Sub-Saharan Africa faces the deepest deficit — with less than 10% of informal-sector workers holding any form of health insurance.
Community-based health insurance directly addresses this gap by creating locally-governed, contributory risk pools that work within informal economies.
open_in_newWHO UHC Monitoring Report 2023Global Health Coverage (2023)
Landmark Peer-Reviewed Studies
The evidence base that shapes our model.
Each study is peer-reviewed, published in indexed journals, and directly informs how Future Health designs, prices, and governs its mutuelles de santé programs.
Major WHO & UN Reports
Global institutional evidence.
swipeSwipe or use arrows to browse all 6 reports
1 / 6 — swipe or use arrows
Deep Dive: The Rwanda Model
The closest proven model to what Future Health is building.
Rwanda's Mutuelle de Santé program is the most rigorously studied community-based health insurance system in Africa. Starting from near-zero coverage in 2000, Rwanda achieved 93% enrollment by 2010 through district-level targets, tiered premiums, and full subsidies for the poorest third of households.
Over a 10-year period: infant mortality fell 62%, under-5 mortality dropped 57%, and facility deliveries doubled. The WHO now uses Rwanda as its primary UHC case study for low-income settings.
Future Health's Burundi program adopts Rwanda's four core design principles: community governance, tiered premiums, national provider integration, and mandatory government subsidies for the poorest households.
open_in_newRead: Sekabaraga et al., Health Affairs (2011)Rwanda CBHI — 10-Year Outcomes
Health Improvements After CBHI Scale-Up (% change)
Burundi Health Expenditure Split
Burundi Baseline
50% of all health spending in Burundi is paid out-of-pocket.
Without insurance, each illness forces a household to choose between care and food. Burundi's UHC index of 38/100 is among the lowest globally — far below the Sub-Saharan average of 46. The target under SDG 3.8 is 100 by 2030.
38/100
UHC service coverage index
$220
GNI per capita — Burundi
548
maternal deaths per 100,000 live births
Our Own Field Evidence
Data from our programs in Burundi — updated quarterly.
Maternal outcomes
Enrolled women are 40% more likely to deliver in a health facility. Antenatal visit completion is 3× higher among insured households.
Child health
Children in insured households complete immunization at 2.7× the rate of uninsured. Under-5 malnutrition is 22% lower.
Medicine adherence
92% treatment adherence for insured TB and HIV patients vs 71% for uninsured — because medicine costs are covered by the benefit package.
Data from Future Health internal program monitoring system. Comparison groups are uninsured households in the same catchment areas. Results consistent with peer-reviewed literature cited above.
Research Agenda 2025–2028
Where the evidence still needs to grow.
We are transparent about what is not yet proven. These are the research questions Future Health is actively working to answer — and where we are seeking academic partners.
Long-term scheme sustainability
What premium-to-claims ratios sustain a mutuelle without external subsidy beyond year 5? We are tracking this across our oldest schemes.
Mobile money integration impact
Does enabling premium payment via mobile money increase enrollment and retention? Our pilot in two provinces will generate the first Burundi-specific data.
Mental health inclusion
No current CBHI scheme in Burundi includes psychosocial care. We are designing a study to quantify the cost of including basic mental health services.
Climate resilience & health shocks
How do mutuelles perform during aggregate shocks — drought, flooding, epidemic? An under-studied vulnerability as climate-driven food insecurity rises.
Academic partnership invitation: If you represent a university, research institute, or global health think tank interested in co-authoring research on community health insurance in Burundi, we welcome collaboration. Contact healthfuture682@gmail.com with the subject line “Research Partnership.”
Evidence-backed. Community-governed. Locally sustainable.
Read about our programs, explore partnership opportunities, or request access to our anonymized field datasets.