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

Will Cuba Follow the Southeast Asia Model?

Decision to restore ties between US and Cuba has some debating whether it will lead to enhancement or regression of democracy for Communist island nation More

Kenyan Designer Finds Her Niche in Fashion Industry

‘Made in China’ fabrics underlie her success More

Report: CIA, Israel's Mossad Killed Senior Hezbollah Commander

The Washington Post story says Imad Mughniyah was killed instantly by a bomb "triggered remotely" from Tel Aviv by Mossad agents 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.
Jefferson's Library Continues to Impress, 200 Years Lateri
X
Deborah Block
January 31, 2015 12:12 AM
Two hundred years after the U.S. Congress purchased a huge collection of books belonging to former President Thomas Jefferson, it remains one of America’s greatest literal treasures and has become the centerpiece of Washington’s Library of Congress. VOA’s Deborah Block reports.
Video

Video Jefferson's Library Continues to Impress, 200 Years Later

Two hundred years after the U.S. Congress purchased a huge collection of books belonging to former President Thomas Jefferson, it remains one of America’s greatest literal treasures and has become the centerpiece of Washington’s Library of Congress. VOA’s Deborah Block reports.
Video

Video Egypt's Suez Canal Dreams Tempered by Continued Unrest

Egypt plans to expand the Suez Canal, raising hopes that the end of its economic crisis may be in sight. But some analysts say they expect the project may cost too much and take too long to make life better for everyday Egyptians. VOA's Heather Murdock reports.
Video

Video Threat of Creeping Lava Has Hawaiians on Edge

Residents of the small town of Pahoa on the Big Island of Hawaii face an advancing threat from the Kilauea volcano. Local residents are keeping a watchful eye on creeping lava. Mike O’Sullivan reports.
Video

Video Pro-Kremlin Youth Group Creatively Promotes 'Patriotic' Propaganda

As Russia's President Vladimir Putin faces international pressure over Ukraine and a failing economy, unofficial domestic groups are rallying to his support. One such youth organization, CET, or Network, uses creative multimedia to appeal to Russia's urban youth with patriotic propaganda. VOA's Daniel Schearf reports.
Video

Video Filmmakers Produce Hand-Painted Documentary on Van Gogh

The troubled life of the famous 19th century Dutch painter Vincent van Gogh has been told through many books and films, but never in the way a group of filmmakers now intends to do. "Loving Vincent " will be the first ever feature-length film made of animated hand-painted images, done in the style of the late artist. VOA’s George Putic reports.
Video

Video Issues or Ethnicity? Question Divides Nigeria

As Nigeria goes to the polls next month, many expect the two top presidential contenders to gain much of their support from constituencies organized along ethnic or religious lines. But are faith and regional blocs really what political power in Nigeria is about? Chris Stein reports.
Video

Video Rock-Consuming Organisms Alter Views of Life Processes

Scientists thought they knew much about how life works, until a discovery more than two decades ago challenged conventional beliefs. Scientists found that there are organisms that breathe rocks. And it is only recently that the scientific community is accepting that there are organisms that could get energy out of rocks. Correspondent Elizabeth Lee reports.
Video

Video Paris Attacks Highlight Global Weapons Black Market

As law enforcement officials piece together how the Paris and Belgian terror cells carried out their recent attacks, questions are being asked about how they obtained military grade assault weapons - which are illegal in the European Union. As VOA's Jeff Swicord reports, experts say there is a very active worldwide black market for these weapons, and criminals and terrorists are buying.
Video

Video Activists Accuse China of Targeting Religious Freedom

The U.S.-based Chinese religious rights group ChinaAid says 2014 was the worst year for religious freedom in China since the end of the Cultural Revolution. As Ye Fan reports, activists say Beijing has been tightening religious controls ever since Chinese leader Xi Jinping came to office. Hu Wei narrates.
Video

Video Theologians Cast Doubt on Morality of Drone Strikes

In 2006, stirred by photos of U.S. soldiers mistreating Iraqi prisoners, a group of American faith leaders and academics launched the National Religious Campaign Against Torture. It played an important role in getting Congress to investigate, and the president to ban, torture. VOA's Jerome Socolovsky reports.
Video

Video Former Sudan 'Lost Boy' Becomes Chess Master in NYC

In the mid-1980’s, thousands of Sudanese boys escaped the country's civil war by walking for weeks, then months and finally for more than a year, up to 1,500 kilometers across three countries. The so-called Lost Boys of the Sudan had little time for games. But one of them later mastered the game of chess, and now teaches it to children in the New York area. VOA’s Bernard Shusman in New York has his story.
Video

Video NASA Monitors Earth’s Vital Signs From Space

The U.S. space agency, NASA, is wrapping up its busiest 12-month period in more than a decade, with three missions launched in 2014 and two this month, one in early January and the fifth scheduled for January 29. As VOA’s Rosanne Skirble reports, the instruments being lifted into orbit are focused on Earth’s vital life support systems and how they are responding to a warmer planet.

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

All About America

AppleAndroid