Interview: Health Care Quality in Africa

Interviewee: Dr Saidu Aliyu Gital 

Permanent Secretary (Rtd), Ministry of Health, Bauchi State, Nigeria

Interviewer: Atlanta Mahanta, Sr. Multimedia Journalist, THE TIMES OF AFRICA

Q1. What health financing reforms are needed to improve the sustainability and performance of African health systems?

A1. The essential elements in health financing reforms in Africa for over a decade have been the following:

• Government annual budgeting mainly from general tax revenue
• Direct out-of-pocket payment by households
• Social Health Insurance Scheme for Formal Sector
• Donor/Overseas Funding

For the reason that there is no size that fits all in health care financing, reforms needed to improve the sustainability and performance of the health system will focus on the following:

• Increased Government’s spending in the health sector by way of increasing the annual budgetary allocation to the health sector. Africa Heads of Government agreed that 15% of the total budget of member countries be allocated to the Health Sector in Abuja 2001. The actualisation of this Abuja Declaration would go a long way in improving health sector performance and sustainability
• Decreasing Out-of-Pocket Spending by Households.

Most households in Africa do not have a prepayment arrangement to access health care services. They, therefore, lack financial risk protection. This affects close to 70% of households. Any program that could decrease this risk is worth venturing into. A prepayment arrangement would be necessary.

• Public-Private Partnerships. A mutually beneficial public-private arrangement could turn around health care service delivery. Government and the private sector could complement each other’s strength to improve overall health care service delivery.
• Donor/Overseas Development Assistance. Many countries can access support from donors mainly from overseas.WHO, World Bank, Bill & Melinda Gates Foundation, Dangote Foundation have all been known to support African Countries finance health care. This assistance, however, has to be coordinated in order to avoid duplication and to ensure maximum utilisation.
• A comprehensive Social Health Insurance Scheme to cover Formal and informal sectors and Community-based Health Insurance.  The Scheme should not stop at the National level but extended to all states of the federation

Q2.What approaches to health financing reforms have Countries tried? What has worked?

A2. The health financing reforms that have been tried by African Countries are the following:

• Government annual budgeting mainly from general tax revenue
• Direct out-of-pocket payment by households
• Social Health Insurance Scheme for Formal Sector
• Donor/Overseas Funding

Government annual budgeting worked until such a time population growth and its consequence on health care services delivery could no longer be accommodated by the usual paltry 6% or less budgetary allocation to the health sector. Out-of-Pocket Payments for health services by the households have increasingly been unaffordable, thereby leaving patients to lack financial risks protection. Challenges in rolling out the formal sector Health Insurance Program through the National Health Insurance Scheme have almost rendered it dysfunctional. This is even when the scheme was limited to the formal sector alone, to the detriment of the informal sector and the community-based insurance scheme. Donor/Overseas funding has relatively worked. This is because such funds come with a well prepared and cost budget and implementation timeline. But lack of coordination of such support gave room for duplication of programs and waste of resources.

Q3. How can health financing reforms help achieve 0ther public health goals?

A3. Public Health Goals hinge on disease prevention and promotion of health for the whole population. A health financing that ensures equity in access to health care services will therefore help achieve other public health goals. This is embodied in a Comprehensive Health Care Financing Scheme. Such a scheme covers the following, among others:

• Formal Sector
• Informal Sector
• Community-Based Insurance

This scheme accords financial risk protection to almost all segments of the society in terms of access to health care at all times, thereby helping to achieve other health goals.

Q4. Can people afford to pay for health services?

A4. People can afford to pay for health services especially if out-of-pocket expenditures are decreased through a robust social health insurance scheme and coordinated donor support program. 

Q5. How can the Government encourage the private delivery of health care services?

A5. The delivery of private health care services on the continent has always been in the interest of the government because they complement the inadequacies in the public provision of services at all levels of care. For instance, in Nigeria, close to half of Family Planning acceptors obtain their supplies from private outlets. In the same vein, private sectors contribute significantly to increase immunization coverage especially among the rich and affluent citizens who are reluctant in presenting their children and wards for immunization in the public immunization centres/sheds. 

The government can encourage private health care delivery by providing not only the enabling environment but also the legal and regulatory framework to enable the delivery of such services. The federal and state Ministries of Health, through the Private Hospitals Registration and Regulating Authorities control the private Medical Outfits in a mutually beneficial manner.