Community Health Endowments

Increasing consumer ownership of the financing and accountability of their health care system.

What are community health endowments?

Community health endowments, or CHE, are simple, locally-managed health care cooperatives that give member households access to basic health center services at preferential rates in exchange for modest pre-paid subscriptions.

In cash-poor households, even modest out-of-pocket costs for health consultations may constitute a barrier to promptly accessing primary health care in the DRC. Local communities are often alienated from the health system and increasingly assume that organizing health care services is solely the responsibility of the Ministry of Health or international NGOs. However, quality universal primary health care cannot be achieved in Congo without healthcare consumers taking more ownership of the financing and accountability of their health care system.


Enrolled CHE subscribers have generated a total of 100,000 FC (about $82,600), two-thirds of which was received by health centers in the last 18 months.

CHE address some of these difficulties. Prepayment options allow members to pay when cash is available and access health care as needed. Group plans balance risks among many members of the community. Fee reductions for cooperative members make it easier for households to get the necessary cash together when an illness occurs.


159 Health Centers

During Y4 of the ASSP project, the average number of health centers benefitting from CHE subscription income rose from about 140 to 159.

Our Approach to Community Health Endowments

ASSP seeks to improve access to primary health care through the implementation of a CHE strategy. CHE reduce the out-of-pocket costs that households have to pay at the time of health service through a cooperative-type model. Specific objectives of this strategy for ASSP include:

  • Increasing demand for and access to routine health center services by reducing out-of-pocket costs for member households.
  • Increasing net revenue for local health centers.
  • Strengthening the sense of ownership of and loyalty to the local health center in community groups.
  • Reinforcing the health zone’s ability to build strong, sustainable partnerships between health service clinics and the communities they serve.

Key Achievements

Health Center Subscriptions

Where individuals have been reluctant to pass subscriptions through a cooperative group, health center workers and subscribers have adapted the program to allow individual households to join the plan by subscribing directly at the health center.

local revenue

Health centers with the highest participation rates are currently adding $800 to $950 per year to local revenues.

Increasing Access to Health Care

Read more about how ASSP is contributing to improved health by increasing access to health care.