News / Africa

Developing Countries Strive to Provide Universal Health Care

The Jacaranda Health Clinic in Nairobi provies child and maternal health services for the poor (A. Gichigi/Results for Development)The Jacaranda Health Clinic in Nairobi provies child and maternal health services for the poor (A. Gichigi/Results for Development)
x
The Jacaranda Health Clinic in Nairobi provies child and maternal health services for the poor (A. Gichigi/Results for Development)
The Jacaranda Health Clinic in Nairobi provies child and maternal health services for the poor (A. Gichigi/Results for Development)
William Eagle
A new study shows progress being made by nine developing countries in Asia and Africa in creating universal health care systems. They are Ghana, Rwanda, Nigeria, Mali, Kenya, India, Indonesia, the Philippines and Vietnam.                                                                               
The study is part of a series of articles on health reforms published in the scientific journal The Lancet.

​Statistics help tell the story. They show how far these countries have come in extending health care to ever-widening sections of society, including the poor.  
 
According to the study (called “Moving Towards Universal Health Coverage: Health Reforms in Nine Developing Countries in Africa and Asia”) more than three-quarters of the populations of Rwanda and the Philippines are now enrolled in health insurance programs. About half are covered in Ghana, Vietnam and Indonesia.

Countries in the early stages of reform, like Mali, Kenya, India and Nigeria, cover  less than 20 percent.
 
The nine countries have each reached a national consensus on the need to extend health care, but their approaches vary.

Improving Revenues
 
Gina Lagomarsino, a managing director at the Washington-based group Results for Development, said finding a stable source of funding is essential. 
 
Some comes from donors, which often provide funding for specific programs to fight malaria, tuberculosis and HIV/AIDS. The report says donor contributions make up about half of all health care funding in Rwanda and about a third in Kenya, but much less in other countries.
 
The majority of the funding in most countries comes from state revenues.
 
In Kenya, taxes are deducted from the paychecks of civil servants and others in the formal, or taxable, sector. Nigeria funds its health coverage for pregnant women and children in part with general revenues made available from debt relief. Some countries, including Rwanda and the Philippines, ask households to pay monthly or annual insurance premiums.
 
Lagomarsino said Ghana, which has one of Africa’s most successful insurance programs, has a tax devoted solely to health care.
 
"In 2000," she explained, Ghana instituted a new value-added or sales tax which was earmarked for the National Health Insurance Scheme, and this has provided a pretty steady stream of revenues to [the effort]. It has allowed Ghana to develop a program that’s got very comprehensive benefits and offers coverage to the whole population."

"Not that everyone is enrolled yet and the program is far from perfect, but they have been able to significantly increase government revenues and at the same time lower the amount people are paying out of pocket."

Risk pools

Some countries use incremental measures to reach the goal of universal health care. One way is to create risk pools, or programs devoted to various groups. 
 
The programs of some countries, such as Kenya and Nigeria, began by targeting civil servants and taxable wage earners. The two countries are now working to include women, children and the poor.
 
Lagomarsino said the goal in many countries is to eventually replace fragmented coverage with one large pool covering everyone.
 
"It allows for cross-subsidies across populations so wealthier people are paying into the same pool as poorer people," she said. "It’s easier to graduate the payments so that the contributions from the wealthy are used to help subsidize the poor. Similarly, the contributions from the healthier can subsidize those of the sicker. So bigger pools means it’s more efficient; everyone pays an average cost."

Private sector support
 
Many of the nine countries studied in Africa and Asia are also integrating the private sector into their plans to extend health care. Advocates say private service providers can improve choice and access to care.
 
"We have found that in the countries that we’ve examined in this study pretty much all of them have set up an independent purchasing agency that allows them to purchase care from providers rather than just handing a budget over to a ministry of health facility," said Lagomarsino.

"And in many of the countries, they have set up a mechanism for purchasing from private sector providers. It varies by country but for example they are doing this in Ghana [and] in Kenya. They also purchase from public providers."
 
Lagomarsino also said that systems combining public and private health care can prevent the development of a two-tiered system – one catering to the wealthy and the other to the poor. She said with the mixed system, subsidies can be used to extend coverage to the poor. But she notes that involving private providers can create some challenges for assuring quality and preventing fraud.

Controlling fraud
 
Lagomarsino said the systems that work best have strong leadership, including skilled civil servants and agencies to ensure that the system functions efficiently.
 
In the future, technology may help improve delivery and prevent fraud. Mobile phone networks, like Kenya’s successful M-pesa, could be used to pay insurance premiums.
 
Technology may also help prevent fraud.
 
"There’s been a lot of interest," she said, "in a system that’s been widely used across India that provides health coverage to the poor, and those people who are enrolled get a SMART card that has biometric data, such as their fingerprints, on it so when they go to receive services, it can be verified that they came and got the service. And then all of the claims are submitted electronically and paid electronically."
 
Lagomarsino said policymakers will benefit from studying these and other cases to design programs that best fit their own countries. She said it’s not just economics, but also culture and politics, that will determine how to provide health care to everyone at an affordable cost.

Listen to report on health insurance in developing world
Listen to report on health insurance in Africai
|| 0:00:00
...    
🔇
X

You May Like

Jihadist Assassin says Goal of Tunisia Murders Was Chaos

Abu Muqatil at-Tunusi’s remarks in a propaganda interview also cast light on attack on Bardo Museum More

Russia Denies License to Tatar-Language TV Station in Crimea

OSCE official says denial shows 'politically selective censorship of free and independent voices in Crimea is continuing' More

Kenyan Startups Tackle Expensive Remittances Through Bitcoin

Some think services could give Western Union a run for its money, though others say it’s still got a long way to go More

This forum has been closed.
Comments
     
There are no comments in this forum. Be first and add one

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
For Obama, It's More Business Than Friendships With World Leadersi
X
Aru Pande
April 01, 2015 9:09 PM
The rift between President Barack Obama and Israeli Prime Minister Benjamin Netanyahu has put a spotlight on the importance of the American leader’s personal relationships with other world leaders and what role such friendships play in foreign policy. VOA's Aru Pande reports.
Video

Video For Obama, It's More Business Than Friendships With World Leaders

The rift between President Barack Obama and Israeli Prime Minister Benjamin Netanyahu has put a spotlight on the importance of the American leader’s personal relationships with other world leaders and what role such friendships play in foreign policy. VOA's Aru Pande reports.
Video

Video Buhari: Nigeria Has ‘Embraced Democracy’

Nigeria woke up to a new president-elect Wednesday, Muhammadu Buhari. But people say democracy is the real winner as the country embarks on its first peaceful handover of power since the end of military rule in 1999. VOA’s Anne Look reports from Abuja.
Video

Video Tiny Camera Sees Inside Blood Vessels

Ahead of any surgical procedure, doctors try to learn as much as possible about the state of the organs they plan to operate on. A new camera developed in the Netherlands can now make that easier - giving surgeons an incredibly detailed look inside blood vessels, all the way to the patient’s heart. VOA’s George Putic has more.
Video

Video Latin American Groups Seek Fans at Texas Music Festival

Latin American music groups played all over Austin, Texas, during the recent South by Southwest festival, and some made fans out of locals as well as people from around the world who had come to hear music. Such exposure can boost such groups' image back home. VOA’s Greg Flakus reports.
Video

Video Stockton Community, Police, Work to Improve Relations

Relations are tense between minority communities and police departments around the United States following police shootings that have generated widely-publicized protests. VOA's Mike O’Sullivan reports from Stockton, California, where police and community groups are working toward solutions, with backing from Washington.
Video

Video Indiana Controversy Highlights Divergent Meanings of Religious Freedom

Indiana’s state government has triggered a nationwide controversy by approving a law that critics say is aimed at allowing discrimination against gays and lesbians. The controversy stems from divergent notions of religious freedom in America. VOA's Jerome Socolovsky reports.
Video

Video Report: State of Black America a 'Tale of Two Nations'

The National Urban League has described this year's "State of Black America" report as a "tale of two nations." The group's annual report, released earlier this month (March), found that under an equality index African Americans had only 72% parity compared to whites in areas such as education, economics, health, social justice and civic engagement. It’s a gap that educators and students at Brooklyn’s Medgar Evers College are looking to close. VOA's Daniela Schrier reports from the school.
Video

Video Film Tells Story of Musicians in Mali Threatened by Jihadists

At this year's annual South by Southwest film and music festival in Austin, Texas, some musicians from Mali were on hand to promote a film about how their lives were upturned by jihadists who destroyed ancient treasures in the city of Timbuktu and prohibited anyone from playing music under threat of death. As VOA’s Greg Flakus reports from Austin, some are afraid to return to their hometowns even though the jihadists are no longer in control there.
Video

Video Ebola Vaccine Trials Underway in West Africa

Ebola has claimed the lives of more than 10,000 people in West Africa. Since last summer, researchers have rushed to get anti-Ebola vaccines into clinical trials. While it's too early to say that any of the potential vaccines work, some scientists say they are seeing strong results from some of the studies. VOA's Carol Pearson reports.
Video

Video Philippines Wants Tourists Spending Money at New Casinos

Tourism is a multi-billion dollar industry in the Philippines. Close to five million foreign visitors traveled there last year, perhaps lured by the country’s tropical beaches. But Jason Strother reports from Manila that the country hopes to entice more travelers to stay indoors and spend money inside new casinos.
Video

Video Civilian Casualties Push Men to Join Rebels in Ukraine

The continued fighting in eastern Ukraine and the shelling of civilian neighborhoods seem to be pushing more men to join the separatist fighters. Many of the new recruits are residents of Ukraine made bitter by new grievances, as well as old. VOA's Patrick Wells reports.
Video

Video Cambodian Land Grabs Threaten Traditional Communities

Indigenous communities in Cambodia's Ratanakiri province say the government’s economic land concession policy is taking away their land and traditional way of life, making many fear that their identity will soon be lost. Local authorities, though, have denied this is the case. VOA's Say Mony went to investigate and filed this report, narrated by Colin Lovett.

VOA Blogs

Circumventing Censorship

An Internet Primer for Healthy Web Habits

As surveillance and censoring technologies advance, so, too, do new tools for your computer or mobile device that help protect your privacy and break through Internet censorship.
More