Presentation (CTI)

OBJECTIVES: This study aimed to assess progress toward universal health coverage (UHC) in Côte d’Ivoire by examining the design, implementation, and performance of the Couverture Maladie Universelle (CMU), the mandatory health insurance system established by Law in 2014 and rolled out nationally in 2019. The analysis focused on how CMU financing arrangements, contribution mechanisms, risk pooling, government subsidies, and health purchasing reforms have shaped equity, financial protection, and the sustainability of UHC-oriented reforms.
METHODS: A rapid review was conducted using peer-reviewed and gray literature published between 2010 and 2025. Sources included academic databases, national policy documents, and reports from development partners.
RESULTS: Findings indicate that Côte d’Ivoire has made notable strides in expanding financial protection through the CMU. The system incorporates mixed-contribution models targeting formal and informal-sector populations, a government-funded medical assistance program for vulnerable groups, and defined-benefit packages that outline essential services. Progress has also been observed in strengthening financial management, establishing provider payment structures, and piloting strategic purchasing approaches. Despite these advances, several constraints limit CMU performance. These include fragmented pools, challenges in mobilizing domestic revenue, low enrollment of informal sector workers, limited digital infrastructure for enrollment and claims processing, and administrative delays in provider reimbursement. Institutional coordination challenges and fiscal pressures further affect scheme stability. Emerging policy responses include digital platforms for CMU enrollment, improved provider contracting processes, community-based outreach to support beneficiary engagement, and refinements to performance-based financing initiatives.
CONCLUSIONS: Côte d’Ivoire has demonstrated meaningful progress in advancing UHC through the implementation of the CMU and related financing reforms. However, persistent institutional, operational, and fiscal barriers continue to constrain the full realization of UHC goals. Strengthening domestic revenue mobilization, enhancing pooling efficiency, increasing CMU enrollment among informal workers, and reinforcing strategic purchasing will be essential for improving equity, financial protection, and long-term sustainability of the CMU and broader UHC reforms.