By Takudzwa Hanyani
From private health insurance schemes and out of pocket spending; the need to improve better healthcare financing mechanisms has never been greater than it is now across Africa in this decade. Africa has 84% of the world’s population, 93% of global disease burden and 11% of global health spending. The astounding figures stand as a true testimony that without efficient strategies for healthcare financing, universal healthcare coverage will be an elusive dream to many Africans. Healthcare financing in Africa has been heavily reliant on donor financing and out of pocket spending and private health insurances schemes which have not been able to provide the much needed finances for poor Africans.
Rwanda has one of the highest healthcare expenditure at 10.7 as per GDP% in Africa despite being a nation constantly tortured by war crimes and effects of genocide. Rwanda is the only country in sub Saharan Africa in which 85% of the population participates in health insurance for their health coverage. Approximately 44.6% of the Rwandese live on less than USD$2 per day nevertheless, Rwanda has managed to make considerable progress in ensuring universal healthcare coverage becomes a reality. The mutual health insurance scheme in Rwanda makes it possible for participation through an annual payment of 1000 Rwandan francs (US$2) per family member. Rwanda remains one of the poorest and most vulnerable countries on the African continent and in the world but it is also one of the best examples across Africa of health financing systems geared towards universal healthcare coverage.
The African continent has been plagued by a series of disease outbreaks, health emergencies and rising chronic disease burden. However besides these mishaps most households in Africa have no form insurance for healthcare coverage. As a result families are likely to use household finances to cater for health needs hence leading families into poverty or absolute poverty. Out of pocket spending should be reduced at all costs if universal healthcare coverage is to be realized. Public subsidies for primary healthcare has been successful on a large scale but there is greater need for pooling of resources to reduce to amount of household expenditure for health. Besides pooling there is greater need for health risk assessment of individuals before enrolling to a private or social health insurance scheme.
One of the world’s most urgent problems is financing and providing health care for the 1.3 billion poor people who live in low- and middle-income countries. Many poor people lack access to effective and affordable drugs and to surgery and other interventions, largely because of weaknesses in the financing and delivery of health care. Community health schemes have worked successfully in other developing countries and should be considered for uptake by other progressive nations. ‘‘Community financing’’ has become a generic expression covering a large variety of health financing arrangements. Microinsurance, community health funds, mutual health organizations, rural health insurance, revolving drugs funds, and community involvement in user-fee management have all been referred to as community-based financing. These instruments have been successful in Pakistan, Senegal and Rwanda where the community was involved in securing financial protection against the cost of illness and in providing access to priority health services.
Community-based health insurance is an emerging and promising concept, which addresses health care challenges faced in particular by the rural poor. For example Zimbabwe has a rural population which is 62% of the population, yet many clinics and hospitals which offer specialist services are located in urban areas. Besides this phenomena at least 89% of the rural population are unemployed and lack meaningful sources of income making private and social insurance inaccessible to the rural poor. With a healthcare budget which has already been postulated by the Permanent Secretary of Mnistry of Health, as “insufficient” and a dwindling donor finances, it means rural people in Zimbabwe will have to use out of pocket spending to access healthcare services.
Health security is increasingly being recognized as integral to any poverty reduction strategy. While the objective of poverty reduction remains of central concern, there has been a shift of focus away from poverty reduction per se to social risk management. Such is the case because of the growing appreciation of the role that risk plays in the lives of the poor .Of all the risks facing poor households, health risks probably pose the greatest threat to their lives and livelihoods. A health shock leads to direct expenditures for medicine, transport and treatment but also to indirect costs related to a reduction in labor supply and productivity. The exploitation of community health scheme strategies should be duly considered for effective emancipation of African communities, families and individuals facing the burden of disease, illness and poverty. With a growing cycle global recession, finances for healthcare can dwindle and the African continent will suffer the inherent shocks.