Expanded access: Universal coverage is rolled out alongside facility upgrades


After an 18-month pilot phase with 108,469 students, Ivorian authorities began the wider rollout of the universal health coverage (couverture maladie universelle, CMU) programme to the broader population in October 2019. The project is a milestone for Côte d’Ivoire’s health care system, where less than 10% of the population has adequate health coverage. It is also expected to boost local pharmaceutical manufacturing.

Universal Cover

Monitored by the National Health Insurance Fund (Caisse Nationale d’Assurance Maladie, CNAM), the CMU was launched in April 2017 with a student-oriented pilot phase. After the pilot programme was successfully completed, the authorities began the wider rollout in 2019, with contributions collected by workers in the formal sector beginning in April. By October 2019 the first medical services were provided under the system. As of April 2020, 3m people were enrolled, with the government aiming to cover 38% of the population by 2023. The authorities had set a March 31, 2020 deadline for enrolment, but it was extended to June 30 of that year due to the Covid-19 pandemic.

The CMU has two tiers of payment: the contributory basic general system offers a package for a monthly contribution of CFA1000 ($1.72) per insured person and is 70% funded by the CNAM. Meanwhile, a non-contributory medical assistance system is available for the financially vulnerable. Both will reduce out-of-pocket expenditures and alleviate the risk of poverty due to significant health costs. “The CMU is an important step towards improving the population’s access to care,” Arouna Diarra, president of the National Order of Pharmacists of Côte d’Ivoire, told OBG. “Every individual will have access to a wide range of services including medical consultations, 24-hour and 48-hour hospitalisations, laboratory analysis, dental care and medications.”


The rollout prompted the authorities to launch a rehabilitation programme of health facilities. As of November 2019, 77 first-contact health facilities were renovated. In June 2019 the first eight hospitals – five general hospitals and three regional health centres – were delivered after being restored and equipped. Moreover, around 720 establishments were selected as part of the initial network of conventional hospitals. However, challenges remain in equipment maintenance. “Health funding is important, but a key factor is maintenance,” Eric Djibo, president and director-general of International Polyclinic Saint Anne Marie, told OBG. “Medical equipment is expensive, and a team of specialised technicians is absolutely necessary to keep hospitals going.”


The rollout of the CMU is expected to increase demand for medications, which presents an opportunity for the local production of pharmaceuticals. Côte d’Ivoire currently imports 94% of its pharmaceuticals, and a 2019 study by Paris-based Sciences Po, Human Dignity and the Ivorian Human Rights Movement found that 80% of Ivorians – especially those in rural zones – turn to traditional medicine, highlighting room for expanded adoption of science-based medicines and health. “Instead of going to the traditional healers, people will be able to go to the hospital to receive care,” Diarra told OBG, emphasising that the programme will be key to ensuring counterfeit medications are taken off the shelves.

Alignment with international standards, as well as an increase in drug production capacity, will be essential for the successful implementation of the CMU. “The CMU will be a driver for the development of the local pharmaceutical industry,” Assane Coulibaly, lead ECOWAS coordinator for the Pharmaceutical Good Manufacturing Practices Roadmap Initiative in the Department of Trade, Investment and Innovation at the UN Industrial Development Organisation, told OBG. “Health coverage rates will rise significantly, leading to an increase in demand for high-quality, locally manufactured medicines. The CMU cannot be successful if it relies solely on imports; we need to invest in the local and regulated production of generic medicines.”