OBJECTIVES: The aim of this study was to explore individual and community factors affecting the decision making process leading to purchase of voluntary health insurance among a rural community in sub-Saharan Africa. Such intervention is crucial in the context given that, by pooling resources and risks across a community, it can increase equitable access to health care services and reduce health disparities. METHODS: The study used qualitative research methods to understand consumers’ preferences in relation to their decision to purchase voluntary health insurance. This approach was considered preferable to quantitative methods traditionally used in demand analysis because of its potential to capture the complexity involved. Thirty-two respondents were selected for an individual in-depth interview using a stratified sampling design based on insurance status, distance to health facility and socio-economic status. All interviews were tape recorded, fully translated and transcribed, analyzed and triangulated by two independent researchers using Atlas.ti software. Data from eight focus group discussions provided an additional valuable source of triangulation. RESULTS: Participants, regardless of insurance status, understood the insurance potential to decrease health inequalities by facilitating access to healthcare services. They justified their decision to purchase or not to purchase insurance in relation to their preference regarding specific elements of the scheme, including the enrollment unit, the benefit package, the management structure, the payment modalities, and the timing of the enrollment campaign. CONCLUSIONS: The use of qualitative methods led to a thorough investigation of consumers’ preferences. It allowed to formulate clear and concise policy recommendations to be used to redirect the scheme design. The qualitative approach proved to be a valuable tool for understanding consumers’ preferences in relation to the formulation of health policy suggesting that in many circumstances, it is to be preferred to traditional quantitative methods as an evaluation technique.