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Ensuring good health: health insurance in sub-Saharan Africa

How can governments in sub-Saharan Africa (SSA) provide universal equitable healthcare to their populations? How can SSA health systems respond to the HIV/AIDS epidemic and to the health needs of the poor? Representatives from a number of SSA governments met with policy advisers from the UK’s Department for International Development (DFID) to discuss possible solutions, to the pressing health problems facing SSA.

A two-day workshop organised by DFID discussed the role and potential of social health insurance (SHI) systems. Although examples of SHI exist in Kenya and Tanzania, the workshop concentrated on the need to improve coverage and equality of provision.

The meeting explored a variety of government-backed SHI schemes. These include tax-based systems that provide services for those employed in the formal sector but also community SHI initiatives. The meeting’s main objectives were to review existing international evidence of SHI performance and to find common knowledge and challenges that can be met by means of sharing best practice. The workshop found that:

Although Europe provides many working examples of SHI, these have not been so successful in Latin America and the Balkans as SHI performance depends on a strong economy.
SHI does not tend to help increase the equality of provision nor the percentage of the population covered. In particular, the poor and those who work in the informal sector tend to receive no health cover under these schemes.
SHI systems have a tendency to concentrate health resources and staff for the benefit of the rich and the insured minority. This often leaves those most in need with access to a decreasing share of the national health budget.

This evidence has serious implications for the implementation of SHI systems in SSA. These include the need for:

containing SHI failures as strategy for financing healthcare, such as its tendency to increasing healthcare treatment costs and its inability to raise new funds for the health budget beyond what the government collects from its own employees
creating the right macro-economic context in SSA so that SHI systems might have a better chance of success. This includes a general improved economic performance, but also the reduction of their vast informal sectors
targeting care and public resources to the poor and to those who are uninsured in a manner that is consistent with the workings of SHI
further studies to forecast the impact that SHI might have on overall health budgets in SSA
a better understanding of the variety of groups with no access to SHI and of their willingness and/or ability to be included in these schemes
more knowledge about possible strategies aimed at providing health coverage to the majority of people in SSA who are poor and uninsured.

Source(s):
'DFID Health Insurance Workshop report', DFID Health Systems Resource Centre, May 2002

Funded by: UK Department for International Development

id21 Research Highlight: 10 February 2003

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