More than 50 policy-makers, implementers, students, experts and civil society representatives from Asia and Africa met on October 31 in Beijing, China, to share and discuss ideas and knowledge on the practical implications of effecting national health insurance schemes and policies. Sponsored by the African Development Bank (AfDB), the World Bank Institute and the Asia Network for Capacity Building in Health Systems Strengthening (ANHSS), the special knowledge-exchange session was part of the second Global Symposium on Health Systems Research.
This is not the first time development partners and governments have sought to share experiences and lessons learnt from other countries and regions. During the Conference of Ministers of Finance and Health on Value for Money, Sustainability and Accountability, organized by the Harmonization for Health in Africa Mechanism in Tunis, Tunisia, in July 2012, a special session was dedicated to learning from the BRICS countries and included input from Brazil, China and India.
The session in Beijing, however, was different in that it focused on linking theories and what is known about health insurance in both Asia and Africa, with the various challenges faced when implementing policies on the ground. Many countries in Africa are looking to either develop some form of health insurance scheme or to broaden existing ones.
Why is sharing knowledge and experience between emerging nations, or "South-South" learning so important? Several countries in Asia and Africa are implementing different types of health insurance schemes aimed at attaining universal coverage. Asian countries, particularly the ones selected for this satellite session, are relatively advanced in addressing similar challenges to those faced by many African countries - how to expand health services to growing populations; how to target services on the poor and disadvantaged groups; while at the same time improving quality with limited resources.
Policy-makers and implementers of burgeoning health coverage schemes hope to ensure that mistakes made in the past are not repeated and that lessons learnt are taken into account. In Africa especially, where the largest burden of disease is carried, there is no room for error in providing much-needed health services for a fast-growing young population.
In the opening session, AfDB Manager for Health, Dr. Feng Zhao, highlighted the high out-of-pocket health expenditures and the low rates of health insurance coverage in Africa. In contrast, the experience from China presented by Dr. Yang Hongwei from the China National Health Development Research Center (CNHDRC) indicated that although high rates of health insurance coverage had been attained, equity and efficiency still remained a challenge.
Other presenters from China included Dr. Song Daping from CNHDRC, who provided an overview of the New Rural Cooperative Medical Scheme in China and Dr. Wen Chen, also from CNHDRC, who spoke about the reform in the Chinese pharmaceutical sector.
India has supported the idea of health for all since it became independent in 1947. Dr. Nishant Jain, Senior Technical Specialist on Health Insurance and Finance at GIZ and Advisor to the Government of India, presented the key achievements in reducing out-of-pocket expenditure as well as the challenges of improving enrolment under the Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) in India. In particular, a vital lesson learnt was the speed at which a relatively new technology such as the smart card was introduced and delivered to the poorest people. Any delay in getting the card, as observed in some countries, makes it much harder to effectively extend health services to the insured. The Africa Panel included delegates from Ghana, Rwanda and Ethiopia.
AfDB Principal Health Economist, Dr. Nejmudin Bilal, presented on why and how Ethiopia embarked on a health insurance scheme. A key lesson from Ethiopia was the process that took place in deciding on and implementing health insurance out of a number of considerations for universal health coverage. Dr. Bilal stressed that stakeholder consensus and political leadership is a crucial factor in the process. Technical soundness and a strong evidence-based foundation were highlighted as necessary for a health insurance scheme, and as such learning from other countries is important so as to not repeat mistakes made elsewhere. Ethiopia has made significant strides in health care, particularly in reducing malaria and approximately halving child mortality in recent years.
On the same Africa panel, AfDB Principal Health Economist, Dr. Caroline Jehu-Appiah, spoke on Ghana's experience in developing health insurance. Ghana's experience is seen as one of the success stories in Africa in terms of population coverage and in reducing catastrophic spending for the poor.
Dr. Jehu-Appiah underlined that Ghana's success has been based on strong political drive and leadership, learning from a previous Mutual Health Organization (MHO) experience in social protection, the principle of national solidarity, and willingness to be innovative regarding financing sources. Ghana's National Health Insurance Scheme shows that it is possible to design and implement a social health insurance scheme not only for the formal sector in Africa, but also for rural and informal sector populations as well.
Dr. Sabine Musange from the Rwanda School of Public Health stressed that Rwanda's efforts are marked by accelerated coverage (community-based health insurance above 80 per cent coverage and a financially sustainable social health insurance, known as RAMA). Dr. Musange noted that the Rwandan experience also showed how the health insurance structures are integrated into the existing government health structures at all levels of the health system. The other key lesson from Rwanda was the combination of health insurance with performance-based contracting that has improved the uptake of preventive health services, improved accountability of health care providers, and improvement in efficiency and quality of care.
Health insurance is a key focus area for the AfDB as part of its Human Capital Development Strategy. The strategy aims to build on the opportunities created by Africa's one billion people through ensuring efficiency and accountability in service delivery, including health, skills development and inclusive and equitable growth on the continent.
