In Part 1, Guest Blogger Udo Obiechefu discussed three major obstacles that West African nations face in their effort to provide accessible quality care for their citizens. In Part 2, Udo explores three solutions that could possibly gain traction as viable options to increase access to care.
Involving the Private Sector: It can be done!
The availability of private health insurance in West Africa is quite limited. Many health insurance plans are only available and marketed to the wealthy and/or expatriate communities. As mentioned in part one, it is apparent that West Africans are willing and able to pay for reasonably priced prepaid services. There is great potential to improve healthcare access and delivery through the availability of well-priced, quality health insurance. What would make the idea of purchasing health coverage more palatable for citizens of West African nations are more reliable health services. Even if given reasonable choices for coverage, there still has to be confidence in the system to provide the care required. The system can be improved if more is done with the resources available. Some of these resources include the user fees that consumers must pay out of pocket and international aid. The idea of providing private health insurance to low income Africans is already being put to practice. The Health Insurance Fund (HIF) is a foundation devoted to achieving this goal. Through the foundation, donor funds and international monetary aid are linked to health maintenance organizations and insurance companies. These organizations are responsible for the execution of the insurance plans. The mission of the Health Insurance Fund is to protect the wealth of low income African families by utilizing private insurance as a means to access quality care. The resources of the HIF are used to upgrade the medical and administrative services of the contracted insurers and providers. The first HIF program was initiated in Nigeria utilizing Hygeia, which is the largest healthcare service group in the country. At this point in time the HIF has over 120,000 enrollees.
Community Based Prepayment: Community Solutions for a Continental Problem
Community based initiatives have the potential to be very effective tools for change. A community based concept that has gained traction in recent years within some ECOWAS nations are Community Based Health Insurance schemes (CBHI). These plans are more accessible than the formal private sector insurance plans currently available to West Africans. Prepayment plans are funded by annual or regular payments. They require reduced fees at the time health services are rendered. Most CBHI schemes involve either hospitalization services or primary care visits. Johannes P. Jutting, in an article analyzing community plans in the Thies region of Western Senegal, came to the conclusion that CBHI plans have the capability of having a strong impact;
“It was shown that in an area where most people are deprived of access to health care of good quality, the introduction of CBHI schemes can make a substantial difference” (Jutting 2003) Community based plans are a common sense approach that provides consumers with more realistic financial options. The availability of flexible payments insures a consumer’s ability to make payments that make sense given their financial circumstances. Community based plans also offer the capacity for providers to create community specific options. A group of plans available in Sikasso, Mali may not be the same as plans available in Taoudenni, Mali. The customizations that are made to payment plans in different communities can be based on demographics, disease prevalence and average income of those living in the geographic area. This flexibility allows for high degrees of adaptation between marketplaces. The success of community based initiatives are not a guarantee. Although it has the potential to provide access to care for large majorities of lower income populations, it still is a concept that struggles to include extreme cases of poverty. There is still much research to be done, but the future is promising. Systems that identify community needs and embrace an approach specific to the region have the potential to produce a more sustainable marketplace for middle and working class West Africans to purchase reliable health coverage.
Natural Resources: Where Are the Revenues Going?
Over the last ten years many West African nations and Africa as a continent has seen substantial growth as the result of increased exploitation of African natural resources. From diamonds in Botswana to oil off the coast of Nigeria, Africa offers a vast array of resources that contribute to the foundation on which most of western society sits. What has become evident during this recent increase in West African economic activity is a severe lack in transparency in relation to the taxation practices that seem to be attracting foreign investors. Liberia’s President, Ellen Johnson Sirleaf, believes that African nations are suffering due to lack of appropriate taxation methods;
“Africa, like the rest of the world, is suffering tremendous losses from the illicit and unwarranted outflow of wealth through tax avoidance, shell companies, tax havens, transfer pricing and others, that in a way leads them to avoid their fair share of taxes,” What should be a vast economic windfall for West African nations and citizens seems to never have a tangible financial impact on the countries from which these resources are being acquired. The 2013 Africa Progress Report concluded that Africa is at a critical point in time where greater investment of natural resource revenue needs to be invested into West African economies. Corruption is a real problem with real economic impacts on West Africans , but a greater issue is the belief of West African governments that an increase in transparency, coupled with stronger negotiations could lead to a loss of business. These ideas must be overcome to gain maximum value and increased revenues for West African. An increased stream of income from ECOWAS nation’s reserves of natural resources could in turn provide the financial ability to improve many of the access to care issues we discussed in part one of this story.
The struggles surrounding health care on the African continent have been well documented. West Africa is no different. For there to be sustainable change within the region the paradigm must be shifted. West African nations must rely more on the ingenuity and resourcefulness of the populations they are seeking to help. Community based solutions offer promising results that involve an approach specific to the region. ECOWAS nations also must look to maximize their potential by increasing transparency and implementing better business practices. Better utilization of already existing sources of revenue will lead to a greater financial freedom. This increase in financial maturity can provide West African governments with the confidence to take many problems in their healthcare delivery systems head on. Improving the access and delivery of care in West Africa is a daunting task. Lack of funding, a small workforce, poor organization, and a dearth of viable private sector solutions has left many nations in dire situations. Although the current environment is not ideal, the future is not completely bleak. With proper investment of aid, a change in approach and an aggressive and forward thinking collection of decision makers West Africa has the opportunity to improve the access and delivery of health services for millions in the years to come. References