At the entrance to the Cocody University Hospital, in the heart of Abidjan, Ivory Coast, the information on a large sign is unmistakable: "Universal Health Coverage (CMU) is accepted." Yet, few patients arrive at the hospital with their insurance card.
Promised ten years ago by President Alassane Ouattara, who will seek a fourth term in October, this social protection system is struggling to become widespread despite the efforts of the government, which in mid-July congratulated itself on having passed the "historic milestone" of 20 million "CMU enrollees," or two-thirds of the population.
The reasons are a lack of information, a lack of confidence, and also a mismatch between prescriptions and the medications covered.
By paying a contribution of 1,000 CFA francs per month (1.50 euros), policyholders theoretically only pay 30% for medical consultations and certain medications, while the poorest benefit from full coverage.
Since 2023, registration with the CMU has even been mandatory to access certain administrative services, which partly explains the explosion in the number of insured persons, which was less than 4 million in 2022.
Ahmed Diomandé, deputy director general of the National Health Insurance Fund (CNAM), welcomes a "dazzling development."
But fewer than 4% of those enrolled used their card in 2025, according to official figures.
Leaning on a crutch, Curtis Djibran grimaces as he leaves the hospital: he underwent foot surgery after a road accident. Although he holds a CMU card, the forty-year-old had to dip into his savings to pay for his care, having failed to pay his premiums, as he explains to AFP.
The same goes for Marie Djèdje, who gave up on CMU after an unsuccessful first attempt. "A card that doesn't work and I'll have to pay 1,000 francs, it's a waste!" she says.
– Awareness campaign –
In recent months, the government has launched a major awareness campaign, involving 4,000 agents, the media, local elected officials and traditional leaders, deploying "CMU villages" and mobile units across the country.
Health issues remain significant in this West African country, where life expectancy at birth is 60 years for men and 64 years for women, according to the United Nations Population Fund – figures that are up from the start of the century, but still behind Senegal or Cameroon.
Many Ivorians still think, like Félix, a civil servant, that the CMU "is useless."
"Every time I tried, they didn't cover my medication," says the fifty-year-old, who uses private insurance at 12,000 francs per month (16 euros).
"Many people sign up but don't use their card," confirms Wilfried Abo, a gastroenterologist at Cocody Hospital. "Most patients complain that many treatments and medications are not covered," continues the young doctor, who also deplores a lack of information.
Several hundred medication references are covered by the CMU, "an evolving basket of care," replies Mr. Diomandé, who assures that studies are underway to expand it to other pathologies such as cancers.
– “Not adapted to needs” –
For Firmin Kra, a doctor of socio-anthropology, "the services offered are not adapted to the needs." He believes that "a broad effort must be carried out with the various stakeholders to collect health data and map health needs."
"CMU was not requested by the population; it was politicians who created the offer," which explains why "citizens perceive it as a tool used by the government to enrich themselves," explains the researcher, according to whom the price of 1,000 francs per person can be a heavy burden for large families.
The main challenge lies in supporting informal workers and farmers, who are most in need of low-cost coverage.
According to the CNAM, fewer than 10% of workers in the informal sector – which represents 88.4% of jobs in Côte d'Ivoire, according to the African Development Bank – have paid their contributions at least once.
The government has multiplied initiatives, for example, by making universal health coverage free for four months this year, and by entering into an agreement with the Coffee and Cocoa Council to cover the contributions of 700,000 producers. But access to healthcare for all is not yet a concrete reality for many Ivorians.
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