Transnational health insurances and the involvement of Congolese immigrants in their relatives' health from abroad

For many years, the migration and development literature has looked at the impact of financial remittances on immigrant relatives’ access to healthcare. More recent work on social remittances also examined the circulation of ideas and practices through migration and its impact on behaviour and consumption patterns in the home country. Surprisingly, however, migration scholars have neglected the interactions between remittances and local health systems in countries of origin. This is all the more surprising considering the abundant literature on health and development that has documented numerous non-governmental initiatives to improve access to care in the Global South in recent years. Among those initiatives, community-based health insurances (CBHI) have attracted significant attention. CBHI are voluntary risk-pooling schemes run by not-for-profit organisations; they collect fees among users at the local level and organise access to care with providers. While the growing literature on CBHI is shedding light on the potential of civil society organisations to replace or compensate for weak public health systems, it forgets that – in many parts of the world – access to the necessary capital to join those schemes is still very dependent on emigration of some family members. In other words, for many families worldwide, strategies to access healthcare have become transnational.

In this paper, I look at a specific form of CHBI that we call 'transnational health insurance' (THI). These insurance schemes are set up by immigrants in cooperation with a multitude of actors including, on the one hand, health insurance companies and development aid agencies in destination countries and, on the other hand, healthcare providers in origin countries. THIs offer health coverage to a selected number of non-migrant relatives in the home country based on a premium paid directly by immigrants to the insurance company in their country of residence. Analysing the creation and implementation of THIs in the Belgian–Congolese postcolonial context allow me to contribute to pressing debates on the nature of such remittances (Are THIs social or financial remittances, or both?), the drivers of immigrant transnational engagement (What are the motivations of receiving country institutions to get involved in such co-development practices? How do these initiatives reflect and/or transform receiving countries’ health systems? How beneficial are they for emigrants and their relatives?), and its impact on communities in origin countries (Do THIs support or hamper access to public health and the development of local initiatives in countries of origin? How sustainable are those strategies as migration becomes more permanent?)

The data used in this paper were collected during multi-sited fieldwork in Belgium and the DR Congo between January 2012 and August 2013 by the co-author of this paper, Olivier Lizin. Fieldwork included long-term participant observation in one THI in Brussels and Kinshasa (Solidarco) as well as 80 semi-structured interviews. Interviewees belonged to the following categories: Congolese immigrants in Belgium; insurance fund managers in Belgium; THI managers in DR Congo; beneficiaries in DR Congo; and development aid workers.