title: Effects of mutual health organizations on use of priority health-care services in urban and rural Mali: a case-control study.
abstract: OBJECTIVE
  To examine the effects of a community-based mutual health organization (MHO) on utilization of priority health services, financial protection of its members and inclusion of the poor and other target groups.
  
  
  METHODS
  Four MHOs were established in two districts in Mali. A case-control study was carried out in which household survey data were collected from 817 MHO member households, 787 non-member households in MHO catchment areas, and 676 control households in areas without MHOs. We compiled MHO register data by household for a 22-month period. Outcome measures included utilization of priority services, health expenditures and out-of-pocket payments. Independent variables included individual, household and community demographic, socioeconomic and access characteristics, as determined through a household survey in 2004.
  
  
  RESULTS
  MHO members who were up to date on premium payments (controlling for education, distance to the nearest health facility and other factors) were 1.7 times more likely to get treated for fevers in modern facilities; three times more likely to take children with diarrhoea to a health facility and/or treat them with oral rehydration salts at home; twice as likely to make four or more prenatal visits; and twice as likely, if pregnant or younger than 5 years, to sleep under an insecticide-treated net (P < 0.10 or better in all cases). However, distance was also a significant negative predictor for the utilization of many services, particularly assisted deliveries. Household and individual enrolment in an MHO were not significantly associated with socioeconomic status (with the exception of the highest quintile), and MHOs seemed to provide some financial protection for their members.
  
  
  CONCLUSIONS
  MHOs are one mechanism that countries strengthening the supply of primary care can use to increase financial access to - and equity in - priority health services.
authors.affiliation: University Research Co., LLC, Bethesda, MD, USA. lfranco@urc-chs.com
authors.forename: Lynne Miller
authors.initials: LM
authors.lastname: Franco
authors.forename: François Pathé
authors.initials: FP
authors.lastname: Diop
authors.forename: Clara R
authors.initials: CR
authors.lastname: Burgert
authors.forename: Allison Gamble
authors.initials: AG
authors.lastname: Kelley
authors.forename: Marty
authors.initials: M
authors.lastname: Makinen
authors.forename: Cheick Hamed Tidiane
authors.initials: CH
authors.lastname: Simpara
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002391:Catchment Area, Health; D002648:Child; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D003256:Community Participation; D005191:Family Characteristics; D005249:Fees and Charges; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006292:Health Priorities; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008302:Mali; D008329:Managed Care Programs / Q000458:organization & administration*; D008875:Middle Aged; D017059:Models, Econometric; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D019035:Rural Health Services; D012959:Socioeconomic Factors; D019037:Urban Health Services; D055815:Young Adult