PIP: The authors of the 1993 World Development Report "Investing in Health," along with other international health professionals, believe rural health insurance in Africa to be unfeasible. However, this belief excludes from the policy debate the option of allowing rural households to make direct financial contributions to the cost of their health care without placing financial barriers to obtaining care at the time of the illness. These detractors suggest that patients pay clinic and hospital fees for consultations and treatments provided in government facilities. Such fees, however, will deter many rural patients, mostly children and women, from seeking health care. The notion that health insurance schemes for rural populations in Africa would not be feasible seems to be based upon assumptions that there is neither preference nor demand for health insurance among these populations, and that schemes would require management structures similar to those of Western health insurance systems. There is little evidence for either contention. Supporting case examples are given from Burundi and the Gabu region of Guinea Bissau.