Community-based mutual health organisations (MHOs) are today regarded as an essential element in the establishment of universal health coverage in sub-Saharan Africa. Nevertheless, their development has been impeded by numerous technical and institutional difficulties. While these obstacles are indeed important, our purpose in the present article is to investigate a paradox that has not yet been examined as such. In their underlying principles, community-based MHOs fall within the scope of the social and solidarity economy (SSE). However, these principles come up against a range of different values and representations within the organisations themselves. This phenomenon is illustrated by a case study of Senegal. A qualitative methodology is adopted in order to compare representations and practices with the criteria of the SSE. Our study shows that, although community-based MHOs are indeed part of the SSE, local constraints and specificities make it difficult to unify the mutualist movement in order to progress towards universal health coverage.