What do we know about how to effectively cover the poorest? What are the options? How can equity in UHC be measured? From September 24th to 27th, around 80 international experts from 12 countries will gather in Morocco. They will work on strategies to ensure that health systems reach the poorest. In this blog post, Allison presents the main objectives of the workshop.
There is enormous global interest today in “universal coverage”, which was the theme of the 2010 World Health Report, the just released Lancet series, as well as of a number of international and regional conferences over the past 18 months, including several focusing specifically on Africa. One key question remains that of access to health care for the poorest, sometimes referred to by policy makers as “indigents”. If the term indigent, whose genesis goes back to the origins of welfare systems, is ambiguous, its definition is clear in the health care sector: individuals who do not have the means to pay for health care and for whom coverage, directly by health care providers or indirectly by prepayment systems, requires public intervention.
Given thus that a large percentage of the population still lives below the poverty line and often up to 80% of households depend on (irregular) incomes in informal sectors in many African countries, combined with severe institutional instability in some cases, reaching universal coverage is challenging for African governments to say the least. Nevertheless, the tangible progress achieved by certain countries such as Rwanda and Ghana demonstrates that universal coverage is not only an economic problem: if political will is sufficiently strong, it is possible to make significant progress to reach universal coverage even with limited resources. However, even in Ghana and Rwanda, where coverage rates are high – around 65% and 90% of the total population, respectively – the poorest are often excluded from national health insurance schemes. Although specific measures - such as exemptions – are implemented to ensure their coverage, these actions remain generally ineffective (1). In Ghana, despite an exemption policy aiming to cover indigent and vulnerable populations, only 1.4% of the indigent population is covered by the National Health Insurance Scheme (2).
African countries are currently experimenting with a number of approaches and mechanisms to improve access to health care for this target population: equity funds, subsidies for health insurance premiums, health care vouchers and even cash transfers. However, none of these mechanisms has yet proved successful in improving access to health care for the poorest on a national scale, highlighting the challenges to reach universal health care coverage.
In co-operation with the Moroccan government and the Joint Learning Network for Universal Health Coverage (JLN), the Financial Access to Health Services Community of Practice (FAHS CoP) is organizing a workshop on the subject of “Equity in universal health care coverage: how to reach the poorest”, which will take place from 24th to 27th September 2012 in Marrakesh, Morocco.
The workshop will bring together representatives of 8 African countries (Anglophone and Francophone) and several resource countries (Asia and South America), as well as CoP members and regional institutions. The workshop will place the emphasis on peer learning and will promote in-depth exchanges between countries and among the various actors within each country. The workshop will also include site visits in order to observe the implementation of RAMED, the Moroccan medical assistance program for the poor.
Like other knowledge activities of the CoP, the workshop will build on discussion, exchange and experience sharing among participants.
Specifically, the Marrakesh workshop objectives are to:
- Place equity within the policy framework of health care financing;
- Identify and document efficient strategies implemented to ensure coverage of the poorest (from African countries and other countries if relevant);
- Diagnose how and why mechanisms intending to cover the poorest have been less successful than desired and seek solutions to overcome weaknesses;
- Identify gaps in knowledge concerning coverage of the poorest and define research priorities;
- Analyze the focus on the poorest populations and link measures taken to national universal health coverage;
- Support participating countries in drawing up action plans to improve their policies on access to health care for the poorest.
As usual, the FAHS CoP will “broadcast” from the workshop on the Google group (CoP-Financial_Access_Health_Services@googlegroups.com) and on the HHA web platform, providing daily updates, interviews, and content, so do stay tuned!
(1) Morestin F &Ridde V (2009). How can the poor be better integrated into health insurance programs in Africa? An overview of possible strategies.Université de Montréal.
(2) Presentation given by Sylvester Mensah, Chief Executive, National Health Insurance Agency, Accra, Ghana at the November 2011 PanAfrican Health Congress on Universal Coverage in Accra.