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In Burkina Faso, the Réseau d’Appui aux Mutuelles de Santé (RAMS) (Support network for community-based insurance) and the Ministry of Social Action and Solidarity organized a solidarity program to improve access to health services for households living in extreme poverty. This case study research aims to understand the program’s emergence and formulation. The results show that this program responds to a need for knowledge about how to improve health insurance coverage for the poorest people through community-based health insurance (CBHI) organizations. However, the program’s formulation led to more profitable solutions for CBHI than for poor people. The lack of consultation and communication during the formulation did allow actors to make decisions corresponding to their own interests.