Health insurance: Moving towards universal health coverage?

Roselyne Sachiti Features Editor
Marion Mambo (43) of Domboshava on the outskirts of Harare is a vegetable vendor trading in Harare’s Central Business District (CBD). Twice a week, in a ramshackle blue truck full of vegetables, Mambo and other female vendors brave the morning chill to travel to Harare’s CBD, drop off along Chinhoyi Street from where they ply their “illegal” trade.

Anything can happen from where she sells her vegetables as the notorious mushika shika cars sometimes drive on pavements. Selling tomatoes and green leafy vegetables, and sweet potatoes, she earns $50 per day whenever she comes to sell, particularly when tomatoes are out of season.

A mother of three children, and knowing the dangers in the area she operates from, she does not miss her funeral policy payment each month, which covers her husband and children.

However, she says she does not have medical aid cover.

Mambo says she would want to get medical aid cover but has failed to do so because she believed most existing health care providers do not cater for people like her who work in the informal sector.

“When I went to one of the medical aid service providers in 2014, they said they wanted a payslip. I did not have one. I never checked with other medical aid service providers as I thought they were all the same. I never checked again at any of the medical aid service providers,” she said.

At the same time, she is unaware of medical aid providers like the Public Service Medical Aid Society (PSMAS) that have packages which target the informal sector.

Under the scheme, the member pays $10; first beneficiary $10; second beneficiary and sub beneficiary $6, adult beneficiary $10. The PSMAS medical aid cover has no age limit and payments can be made electronically and various banks.

Another example is CIMAS which has individual medical health insurance plans that also cater for the informal sector.

Enquiries made through their call centre revealed that they have the Basic Care Plan under which those in the informal sector can pay up to $21 per month, Primary Plan $26 and i Care $89. However, the packages cover people 59 years and below and does not cater for those above that age. Payments can be made through Ecocash, banks on the 25th day of each month.

But, even with such packages, today less than 10 percent of Zimbabwe’s population is covered under medical aid and the bulk of the population has to pay for healthcare out of pocket.

PSMAS Public Relations manager, Mr Arthur Choga, says they cannot ignore the informal sector as it is currently a key driver of the Zimbabwean economy.

“Most people find themselves in the sector and some have built up their businesses to the extent that even when the economy improves they are not likely to move from that sector. We have made inroads into that sector because we believe that better quality of life provided by having medical aid and associated wellness programmes is key to economic development,” he said.

Mr Choga added that universal health coverage is important for any nation.

“At the moment people covered by medical insurance make up 10 percent of the population. It is important for everyone to have a safety net of some kind to enable people to contribute better economically. When people are healthy, they become more productive,” he explained.

According to Mr Choga, the ideal situation is to take medical aid coverage up to 80 percent of the population and they will need several interventions.

“There is need for the involvement of all stakeholders in a coordinated approach to ensure affordable quality health care. Upgrading of infrastructure to meet the increase in demand and upgrading skills among service providers to cope with greater demand is important. To make this happen, we need to come up with a model of sustainable funding and viable tariffs,” he said.

On a blog, the Pharmaceutical Society of Zimbabwe points out three primary drivers of the decline in health insurance.

Listed reasons include a breakdown in the current system due to poor relations between many existing insurers and doctors stemming from non-payment and long lead times for payments, an increasing demand for up-front cash calls and circumvention of the system as actors mistrust and avoid current structures and declining levels of customer service. The blog also says there is a significant shift away from employer sponsored health insurance leading to a decline in the number of insured.

Universal Health Coverage (UHC) means ensuring all people can access quality, essential health services without financial hardship, those who do not have coverage and stakeholder involvement is paramount.

Health funders will converge in Sun City, South Africa for the 19th Annual Board of Healthcare Funders of Southern Africa (BHF) conference from June 17 to 20, 2018.

Themed “Putting the health citizen first, pushing the boundaries of the impossible”, the conference will focus on prioritising the health citizen and how the industry can translate technical evidence and knowledge into policy and action as countries across the southern Africa region begin to progress towards universal coverage.

“The objective for this year’s conference is to get the industry to push boundaries and explore ways to work together to find solutions that are aligned with the important principles of Universal Health Coverage, says Dr Katlego Mothudi, managing director, Board of Healthcare Funders of Southern Africa (BHF).

BHF is a representative body for medical schemes, administrators and managed care organisations across eight countries in the southern African region, namely Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, South Africa and Zimbabwe.

“A lot of research has been conducted in relation to UHC theory and policy evidence — and the implementation will require an inclusive process and for all stakeholders to collaborate in the interest of the health citizen. Our aim for this year’s conference is to map out priority areas for the health citizen and agree on implementable action items to ensure that private sector healthcare industry players across the region pro-actively gears towards UHC,” says Dr Mothudi.

A number of questions remain on how to overcome fragmentation in healthcare as African countries begin to make progress towards this Global agenda to achieving access for all by 2030.

How can the public and private sector scale up information systems and technology infrastructure to create access to health?

Since we need to explore platforms that can be used to hear the voice of the marginalised, how we can incorporate the voice of civil society, business in the discourse? How do we answer to the inevitable consequence of the requirement to scale up quite rapidly as a response to the changing and merging of the two environments?

These are some of the questions for consideration when we interrogate how the industry can translate technical evidence and knowledge into policy and action as we progress towards universal health coverage.

Discussions at this year’s conference, among other issues, will focus on addressing these questions and identifying areas in which the health citizen can be prioritised and a way forward with action plans to ensure that private healthcare industry players also begin to play a more proactive role in enabling the success of UHC.

According to Dr Mothudi, there are a number of actions that the private sector industry players can already begin to implement as priorities to meet the needs of the health citizen.

These interventions can then address specific health challenges, as can the design of scheme benefits that actively improve overall health, risk pooling, cross subsidisation, as a way of enabling de-fragmentation of systems. Engagements are also required around the concept of strategic purchasing of health care services.

The 19th BHF Conference is expected to bring together speakers from around the world to share experiences of implementing universal health care in their countries and to provide insights into what can be applied.

Political analyst Dr Somadoda Fikeni is expected to deliver an opening address on “Putting the health citizen first”.

Fred Swaniker, Founder and CEO of the African Leadership Group, will give a keynote address on “Leaders who messed up and the generation that can fix it”. He will give insights into ethical leadership and the need to focus on empowering the generation that will fix this continent.

“Catherine Duggan (Rwanda) a Professor of Management and political economy and Vice Dean for Strategy and Research, African Leadership University School of Business (ALUSB) will revive our passion for the continent by focusing on the resources in the continent, and why Africa needs as a collective to start reposition the continent to be part of the value chain.

“We can learn a lot through shared experiences and identifying what has worked in other countries, understanding how those systems have been implemented and adapt lessons to our context,” says Mothudi.

Dr Mohsen George (Egypt), managing director and vice president of the Health Insurance Organisation, is also expected to share experiences of implementing universal healthcare in Egypt

Having been instrumental in driving Kenya’s National Health Insurance Fund, Dr Amit Thakker, the founder of the East Africa Healthcare Federation, co-founder of Avenue Healthcare, chairman of the Africa Healthcare Federation and the Africa Health Business Ltd (AHBL) as well as the Kenya Healthcare Federation (KHF), will share lessons from various countries on how governments are removing regulatory barriers to allow Public Private Partnerships.

Kuldeep Singh Rajput from Singapore, Founder and CEO of Biofourmis, will also share experiences of developing how they are using technology to improve health outcomes in South Africa.

Natalie Africa (US), senior director for Global Health and Private Sector Engagement at the United Nations Foundation, will share insights on various programmes around the world that are focusing on women as custodians of health.

David Popik (US), senior director of the Special Investigations Unit, Florida Blue and Chairman of the NHCAA Board of Governors, will share global insights on how the industry can prevent fraud, waste and abuse.

Several other speakers from the region are expected to speak and hopefully their resolutions will trickle back so that women like Mambo working in Zimbabwe’s informal sector can enjoy universal health coverage.

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