Advancing Universal Health Coverage in Comoros with openIMIS

Comoros has taken a significant step toward achieving Universal Health Coverage (UHC) by strengthening the implementation of its Generalized Health Insurance (AMG) program. This program is a national health financing scheme designed to pool contributions and public funding to reduce out-of-pocket payments and improve access to care for all sections of the Comorian population, including the most disadvantaged. For Comorian families, this means fewer households forced to forego care because of cost, and greater protection against the financial shock of illness. The openIMIS platform serves as the key digital backbone supporting the government’s management of enrolment and claims processing within the system.

Moroni, capital of the Comoros, with the port and Badjanani Mosque — © Woodlouse

In collaboration with the AMG technical management unit (UTGAM – Unité Technique de Gestion de l’Assurance Maladie), the government body under the Ministry of Health responsible for leading the AMG scheme has driven the customization of the openIMIS platform to address Comoros’ specific requirements, with the technical support of the PAAMG project, the consortium AEDES-Swiss TPH, and IT partners Y-Note and Etech. This includes tailored functionalities for polygamous family structures, new facility types, and pre-authorized services. The pilot phase, officially launched in December 2025 on the island of Mohéli, covers seven districts and targets approximately 63,610 households representing more than 318,000 people. Early progress is promising, with over half of the target population already pre-registered and 68 contracted health facilities integrated into the system.

The Comorian government has made universal health coverage a national priority, with the AMG firmly inscribed in the Finance Act and supported at the highest level of the State. The Generalized Health Insurance Support Project (PAAMG) is the sovereign vehicle through which this ambition is being operationalized, with a €16 million investment from the Agence Française de Développement (AFD) serving as a development partner in support of this government-led initiative. The government directly finances contributions for poor populations through state subsidies, develops policy and governance frameworks, and strengthens UTGAM’s capacity to manage the scheme — ensuring that the AMG is genuinely institutionalized as a pillar of national social protection.

The AMG system itself is structured around five core pillars:

enrolment
contracting and purchasing of healthcare services
information systems
communication
financial management

Together, these components aim to create a sustainable and equitable health financing system capable of reducing catastrophic health expenditures and improving access to essential services. In concrete terms, this architecture is designed to ensure that a family does not have to choose between seeking care and covering basic needs — and that a patient attending a contracted facility receives services without first having to pay out of pocket.

From the outset, the government designed the AMG not only as a digital health insurance tool but as a lever for deeper governance reform — strengthening UTGAM’s institutional capacities, building evidence-based policy frameworks, and embedding a culture of data-driven management in the health system. The ultimate goal, as defined by the Comorian authorities, is an equitable and resilient system where every citizen, regardless of income or geography, can access the care they need without fear of financial ruin.

Comorian government’s determination to make quality healthcare a right accessible to all is commendable, and this collaborative effort will improve health outcomes and reduce financial barriers to care.

Read more about the PAAMG project here (in French):

Read more about the AMG’s pilot program here (in French):