Enabling access to healthcare to the most vulnerable

Supporting mutual health insurance schemes and involving health authorities to reduce maternal mortality in Guinea and Chad

Health authorities will only be able to reduce maternal mortality (Millennium Goal 5) and sustain these outcomes beyond the projects that have helped achieve them by cooperating closely with civil society (NGOs and communities).

B. Galland, Project Manager

Location of Project Guinea (Forested Guinea Region) - Chad (Mayo Kebbi Region)

Name of Association International Center for Development and Research (CIDR)
Project Partners
(financial and operational)

Operational partners:
Guinea, the Union of Mutual Health Forest Guinea (UMSGF)
and in Chad, The BELACD, Liaison Office for Charitable and Development Actions

Financial Partners:
APNDS Guinea, UNHCR, UNICEF, EU

Program description

In both regions focused on by the project (the Prefectures of Beyla, Yomou and Gouécké in Forested Guinea the Republic of Guinea, and the Pala and Gounou Gaya prefectures in the Region of Mayo Kebi in Chad), the rate of maternal mortality is one of the highest in the world.

In an attempt to reduce this figure, the Governments of both countries have opened up free maternal healthcare services. However, the expected increase in the number of women agreeing to give birth in health centers did not materialize, due to the many barriers to access to health centers and hospitals: the lack of vehicles, high transportation costs in emergencies, the unpredictability of the amount to be paid despite the free service announced by the State, deeply-rooted cultural practices that often force women to give birth in their village, and a style of reception in health centers and hospitals that tends to demean women.

To remove these barriers, communities need to be aided, and measures taken to ensure safety for women and an understanding that giving birth does not entail a risk of dying.

To achieve this, the CIDR has proposed to communities of Forested Guinea organized in mutual organizations to benefit from services that enable them to reduce the risk women incur of dying during her pregnancy because she decided to give birth in the village by offering them "a "SAFE MATERNITY" services package. This will train midwives to handle early referrals, organize prenatal visits in the villages, plan for the monitored delivery of high-risk pregnancies, call an ambulance in an emergency, and monitor effective, free-of-charge healthcare.

To benefit from these services, the villages must commit contractually to educate women and contribute to the costs. Highly significant outcomes have already been obtained with this approach, and this project plans to evaluate its impact:

Key figures



  • Probability that a pregnant woman dies during childbirth: Forested Guinea 4.5% and Chad1.1%.
  • In Forested Guinea, a woman has a one in four chance of dying during the average of six pregnancies she will have during her lifetime, and one in 14 in the Mayo Kebbi in Chad.
  • Less than one in every four women give birth in a health center in Mayo Kebi in Chad and in Forested Guinea
  • In villages that belong to the "Safe Motherhood" program, the recorded maternal mortality rate has been reduced 10-fold, and the birth rate has doubled.

Project goals

The overall objective of the project is to contribute to the sustainable reduction of maternal mortality by promoting a partnership between health authorities and communities organized around mutual health insurance schemes.

This involves designing mechanisms for supporting pregnant women, coordinated with mutual health insurance schemes and free-of-charge schemes created by the health authorities to reduce the barriers to accessing health services and effectively enjoy the free health care they need.

    With funding from the Foundation:
  • seven new mutual schemes will be created and 17 mutual schemes will promote the "Safe Motherhood" approach.
  • the liability of 60,000 women of childbearing age living in 90 villages will be reduced
  • 30,000 pregnant women will:
    • be able to have their pregnancy monitored near their own village
    • encouraged by their midwife to give birth in a health center
    • benefit from a solution for evacuating them to a hospital in case of complications
    • receive proper care delivered by health services
  • The results of the program will be monitored and reported to the health authorities so that the approach can be developed beyond the scope of this project.