News / Africa

Expanding Health Insurance in Developing Countries

Rwanda will host regional conference on health insurance.Rwanda will host regional conference on health insurance.
x
Rwanda will host regional conference on health insurance.
Rwanda will host regional conference on health insurance.
Joe DeCapua
Rwanda will host a regional conference next week (9-11/13), with a focus on health insurance. Rwanda has been praised for moving toward universal coverage for its population. But many say it’s a complicated issue that does not have a one-size-fits-all solution.

The Conference on Social Health Protection in the East African Community will consider various approaches to providing universal health coverage in Rwanda, Uganda, Kenya, Tanzania and Burundi.

Universal coverage is the subject of a new study that reviewed health systems in 12 African and Asian countries.

The World Health Organization’s Joe Kutzin says universal coverage is more of a “direction than a destination.”

“What it means you want to move towards universal coverage, which means you want to improve access. You want to improve financial protection and you want to improve quality. And in that sense, those are goals for every country in the world. So it’s relevant to every African country, every European country, the U.S. and so on, to make progress towards those goals,” he said.

Kutzin is coordinator of health financing policy and analyzed the study published in the Bulletin of the World Health Organization.

Dr. Ernst Spaan, one of the authors, said, “There is a lot of debate going on on how to finance health services in developing countries. In Asia and Africa there is a lot of debate on should they focus on social health insurance or community-based health insurance? And we actually looked into that and we found out there are a lot of studies, but it’s a bit patchy. So we decided to do a systematic review of the literature.”

Spaan is a senior researcher and lecturer in public health at the Radboud University Nijmegen Medical Center in the Netherlands.

The study looked at what he calls impact indicators. These include the way financial resources are collected to fund insurance plans, the amount of coverage provided to recipients, whether that coverage is provided to all segments of society and whether there’s been an improvement in the quality of life.

It says social and community health insurance plans “hold untapped potential” for achieving universal coverage. But Spaan says for that to happen, funding issues need to be addressed. For example, he says social plans are generally mandatory and may be funded through payroll deductions.

“That of course poses a problem in many developing countries because of the fact that the informal sector is quite large. Sometimes even 60 percent of the population or higher is not in formal employment. Also because of the large agricultural sector income is dependent on harvest times, so it’s also very erratic,” said Spaan.

WHO’s Kutzin said some insurance systems may also require a user fee that’s paid at the time of medical services.

“When people have to pay a lot at the time they use services it poses a real, severe economic risk to their households. Very often you find cases where, for example, people have to sell off their assets, whether that is in cash or in animals.  Whatever may be the main source of wealth, people are selling off their assets in order to raise the money to pay for care,” he said.

Spaan and his colleagues also looked at community insurance plans.

“These are organized, generally, on a smaller scale. And in many countries you find these schemes are linked to, for instance, one hospital or even to a school. So they insure school children, for instance, or they insure the people around a certain health facility. But what is more important is that it’s a certain scheme where the local population is more involved in the set-up of the scheme. And least that’s the ideal,” said Spaan.

He added that the study’s findings “back the World Health Organization’s view that pre-paid financing mechanisms, such as health insurance, are a key route to universal coverage.”

But Kutzin said there are many ways to provide health coverage besides those presented in the study.

“One of the best known cases we have is from Thailand, which in 2002 instituted a program called the Universal Health Coverage Scheme. It’s neither community-based nor is it contributory. It is a system where the government using general tax revenues puts all of that money into a single pool. And anyone is entitled to sign-up for the program. They don’t have to contribute anything. That pool pays for services on behalf of the entire population,” he said.

He said Rwanda uses a multiple funding approach for its mandatory health coverage, including general tax revenues and donor funding. And it uses its community-based systems in a coordinated way.

Universal health coverage has been a controversial topic here in the United States, but not in many other countries. Kutzin said that’s because there has not been a clear discussion about what universal coverage is trying to achieve. He says the main question is whether two people, one rich and one poor, with the same medical condition, have access to the same treatment?

You May Like

US Storm Falls Short of Severe Predictions, Yet Affects Millions

NYC mayor says, 'This is nothing like we feared it would be,' yet blizzard warnings, travel bans remain for several East Coast states More

Millions of Displaced Nigerians Struggle with Daily Existence

Government acknowledges over a million people were displaced in 2014 due to fight against Boko Haram insurgency More

Facebook: Internal Error to Blame for Outages

Temporary outage appeared to spill over and temporarily slow or block traffic to other major Internet sites More

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Obama Urges Closer Economic Ties During Historic India Visiti
X
Aru Pande
January 26, 2015 9:33 PM
U.S. President Barack Obama says the United States and India must do better to capitalize on untapped potential in their economic relationship - by removing some of the roadblocks to greater trade and investment. As VOA correspondent Aru Pande reports from New Delhi, Obama spoke after participating in India’s Republic Day celebration.
Video

Video Obama Urges Closer Economic Ties During Historic India Visit

U.S. President Barack Obama says the United States and India must do better to capitalize on untapped potential in their economic relationship - by removing some of the roadblocks to greater trade and investment. As VOA correspondent Aru Pande reports from New Delhi, Obama spoke after participating in India’s Republic Day celebration.
Video

Video US, EU Threaten New Russia Sanctions Over Ukraine

U.S. President Barack Obama has blamed Russia for an attack by Ukrainian separatists that left dozens dead in the port of Mariupol and cast further doubt on the viability of last year’s cease-fire with the Kyiv government. VOA’s Michael Bowman reports from Washington.
Video

Video White House Grapples With Yemen Counterterrorism Strategy

Reports say the U.S. has carried out a drone strike on suspected militants in Yemen, the first after President Barack Obama offered reassurances the U.S. is continuing its counterterrorism operations in the country. The future of those operations has been in question following the collapse last week of Yemen’s government. VOA White House correspondent Luis Ramirez reports.
Video

Video Kerry Warns Against Violence in Nigeria Election

US Secretary of State John Kerry visited Nigeria Sunday in a show of the level of concern within the U.S. and the international community over next month’s presidential election. Chris Stein reports.
Video

Video Zoo Animals Show Their Artistic Sides

The pursuit of happiness is so important, America's founding fathers put it in the Declaration of Independence. Any zookeeper will tell you animals need enrichment, just like humans do. So painting, and even music, are part of the Smithsonian National Zoo's program to keep the animals happy. VOA’s June Soh met some animal artists at the zoo in Washington. Faith Lapidus narrates.
Video

Video Worldwide Photo Workshops Empower Youth

Last September, 20 young adults from South Sudan took part in a National Geographic Photo Camp. They are among hundreds of students from around the world who have learned how to use a camera to tell the stories of the people in their communities through the powerful medium of photography. Three camp participants talked about their experiences recently on a visit to Washington. VOA’s Julie Taboh reports.
Video

Video Saudi, Yemen Developments Are Sudden Complications for Obama

The death of Saudi Arabia's King Abdullah and the collapse of Yemen’s government have cast further uncertainty on U.S. efforts to fight militants in the Middle East and also contain Iran’s influence in the region. VOA White House correspondent Luis Ramirez reports on the new complications facing the Obama administration and its Middle East policy.
Video

Video Progress, Some Areas of Disagreement in Cuba Talks

U.S. and Cuban officials are reporting progress from initial talks in Havana on re-establishing diplomatic ties. U.S. Assistant Secretary of State (for Western Hemisphere Affairs) Roberta Jacobson said while there was agreement on a broad range of issues, there also are some “profound disagreements” between Washington and Havana. VOA State Department correspondent Pam Dockins has the story.
Video

Video US, Japan Offer Lessons as Eurozone Launches Huge Stimulus

The Euro currency has fallen sharply after the European Central Bank announced a bigger-than-expected $67 billion-a-month quantitative easing program Thursday - commonly seen as a form of printing new money. Henry Ridgwell reports for VOA from London on whether the move might rescue the eurozone economy -- and what lessons have been learned from similar programs around the world.
Video

Video Nigerian Elections Pose Concern of Potential Conflict in 'Middle Belt'

Nigeria’s north-central state of Kaduna has long been the site of fighting between Muslims and Christians as well as between people of different ethnic groups. As the February elections approach, community and religious leaders are making plans they hope will keep the streets calm after results are announced. Chris Stein reports from the state capital, Kaduna.
Video

Video As Viewership Drops, Obama Puts His Message on YouTube

Ratings reports show President Obama’s State of the Union address this week drew the lowest number of viewers for this annual speech in 15 years. White House officials anticipated this, and the president has decided to take a non-traditional approach to getting his message out. VOA White House correspondent Luis Ramirez reports.
Video

Video S. Korean Businesses Want to End Trade Restrictions With North

Business leaders in South Korea are calling for President Park Geun-hye to ease trade restrictions with North Korea that were put in place in 2010 after the sinking of a South Korean warship.Pro-business groups argue that expanding trade and investment is not only good for business, it is also good for long-term regional peace and security. VOA’s Brian Padden reports.

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