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Given Madagascar’s socio-economic situation, studies by national and international experts show that only 8% of the population would be able to contribute to a “mutual health insurance scheme”, in the highest hypothesis. If the Malagasy government were to choose to rely exclusively on “mutuelles de santé” to accelerate the implementation of the CSU, following the example of Rwanda and Senegal, it would have to be prepared to foot 90% of the bill, on the one hand, and, on the other, envisage a real impact only in the long term (several decades).