The Healthcare System in the Comoros: Public, Private, Access to Care and Health Risks

The Comoros archipelago has three islands, Grande Comore, Anjouan and Mohéli, and nearly 900,000 inhabitants according to the World Bank. The indicators reflect a healthcare system under heavy constraints: current health expenditure of about USD 100 per capita (about 6.5% of GDP), fewer than one doctor per 1,000 inhabitants and life expectancy of about 67 years. Households directly finance more than half of health expenditure, which puts out-of-pocket costs in the foreground.

France Diplomatie describes a weak healthcare system on all three islands, which often means medical repatriation when hospitalisation is needed. The safety page specifies that provision is ‘unsatisfactory’ in the capital and ‘non-existent’ on Anjouan and Mohéli. It names no hospital or care facility; emergency contacts can be read on the page of the French embassy in the Comoros.

The Comoros are not on the list of States linked to France by a social security agreement published by CLEISS (the French liaison centre for social security abroad): the carte Vitale opens no rights there, and there is no coordination between the two schemes. An employee recruited locally comes in principle under the Comorian scheme to which the employer contributes; the extent of benefits, the facilities concerned and the conditions of access for a foreign employee should be confirmed with the Comorian social security fund and the employer, as the official pages consulted do not detail them.

For self-employed people, retirees, families and tourists, there is no scheme open as of right: cover comes through the CFE (Caisse des Français de l’Étranger, the French expatriate social security fund), international health insurance or, for a seconded employee, continuation of the French scheme. The page on healthcare reimbursement in the Comoros details each situation.

The official pages consulted do not describe a family-doctor system comparable to that of France: a resident chooses a doctor according to their cover, checking with their insurer the conditions of direct payment. Given the situation described on Anjouan and Mohéli, choosing housing on these islands requires a precise evacuation plan.

The French embassy in the Comoros publishes the following numbers: 24-hour duty line for a life-threatening or extremely serious emergency, +269 773 03 95; switchboard during opening hours, +269 364 50 00 or +269 364 50 01; fire brigade, 111, 112 or 113; gendarmerie, 118; SAMU El-Maarouf, 115. The France Consulaire service answers Monday to Friday from 8 a.m. to 4 p.m., Paris time, on +33 1 88 24 56 77. It is advisable to save as well the number of the assistance provider in your contract and the address of the facility closest to home.

France Diplomatie recommends taking only the medicines needed, in their original packaging, with a prescription written using the international nonproprietary name, and checking that they are authorised locally. It advises against any purchase of medicines on the street, because of the risk of counterfeits. For long-term treatment, a supply for the whole length of the stay is preferable.

The insurance contract should also be read from the medicines point of view: coverage of chronic treatments, any prior agreement, delivery or reimbursement during a stay on an island where supply is limited. Passing travellers can enter their contract number in the Ariane system.

The French vaccination schedule must be up to date (diphtheria, tetanus, polio, whooping cough, measles). Depending on the length and conditions of the stay, France Diplomatie mentions hepatitis A and B, typhoid, tuberculosis for children under 15 on frequent or prolonged stays, rabies, notably for young children in rural areas, chikungunya, dengue and mpox in the event of risk exposure.

Mosquito-borne diseases are chikungunya, dengue (with possible epidemics, notably during the rainy season), malaria and Zika. Cholera, typhoid, hepatitis A, mpox, rabies and tuberculosis are also among the risks cited. Prevention rests on protection against bites, water and food hygiene, caution around animals and avoiding risky sexual behaviour.

Before departure, a check-up with the family doctor and the dentist avoids having to look for scheduled care on the spot. The vaccination record is up to date, usual treatments are taken in sufficient quantity with a prescription using the international nonproprietary name, and the insurance contract is checked on three points: cover for evacuation to La Réunion, handling of pre-existing conditions and conditions of direct payment.

On the spot, it is useful to save the numbers of the embassy, the SAMU and the assistance provider, to register with the Ariane system and to keep up with alerts. France Diplomatie reminds travellers to check before travelling that the insurance really covers the stay, to protect themselves from mosquitoes, to observe food and water hygiene, to avoid risky sexual behaviour and to keep away from animals. For travel between the islands, it is better to prefer air travel and authorised sea operators.

Given the weakness of the healthcare system, most hospitalisations go through evacuation to La Réunion, sometimes to Mayotte or mainland France. An assistance contract or insurance covering medical costs, surgery, hospitalisation and medical repatriation is essential; without it, access to care may be refused, even in a life-threatening emergency. It is compared on the annual ceiling, evacuation to the usual destination, the handling of pre-existing conditions and direct payment.

The notions of medical evacuation and medical repatriation help to read the offers; the page on expat health insurance presents the solutions, and Expavy helps to compare them against your situation. For settling in, see living in the Comoros.