Mobile phones are becoming one of the world’s most important health tools, used in many countries to track exercise, ensure medicines are genuine, and even to read blood glucose levels.
In Gabon, they’re being used to raise revenue for the national health system.
A 10% levy on the revenues of mobile phone companies and on mobile phone usage, introduced by Gabon’s government in 2008, has helped to more than double the funds for a health insurance programme that now covers 99% of the equatorial nation’s poor, giving them access to critical health services such as care during pregnancy.
The levy is one of a set of measures that increased enrolment in health insurance plans in Gabon to 45% of the population in 2012 from less than 20% in 2007.
Gabon is one of more than 100 countries that have approached WHO for advice on how to move towards universal health coverage to ensure that their populations can access quality health services without suffering financial hardship.
“From the start the government put the focus on the poor, and then they implemented reforms quickly,” said Dr Hélène Barroy, a WHO senior health financing specialist who co-authored a review of Gabon’s health finance reforms last year.
“In just 5 years they are now covering basically all of their poor.”
The first national health insurance programme Gabon started on the road to universal health coverage in 2007, when it passed a law creating the country’s first national health insurance programme. The following year it introduced the mobile phone levy, as well as a tax on foreign financial transfers, both of which were earmarked for the health system.
Since then, the government has expanded the insurance programme to include the poor, students, civil servants and employees of private companies.
Since the inception of the programme, catastrophic health expenditures, where households incur health costs that exceed 40% of household spending, have dropped from 35% to 21%, said Dr Boureima Hama Sambo, the WHO’s representative in Gabon.
Almost 900, 000 people now have health insurance cover in Gabon, of which more than two-thirds are considered poor.
The reforms have eased the financial burden on households. Out-of-pocket spending declined to 21% of total health spending in 2014, from 51% in 2008. The government has built new hospitals with modern medical equipment in an effort to increase its standard of health-care to that of other middle-income countries.
Financial burden of healthcare costs
Those reforms have led to tangible health benefits. The number of children with malnutrition has halved, and 90% of births now take place in a clinic or hospital. The rate of new HIV infections has been halved since 2001, and the proportion of HIV-infected people who can access treatment is five-fold higher than in 2002.
Still, many of the country’s health indicators remain comparable to those of poorer nations. Gabon has a life expectancy of 63 years, compared with an average of 74 years in other upper-middle-income countries. Deaths in childhood and childbirth are similar to those of low-middle-income countries, and malaria remains the biggest cause of sickness and the main cause of death for children under 5.
Gabon also has increasing rates of high blood pressure and obesity, and heart disease, diabetes, cancers and other non-communicable diseases are becoming a major public health problem. The country has more than enough hospital beds, and an adequate number of health workers, but its primary care system is weak, especially in regional areas.
The national insurance programme doesn’t currently cover those who work in Gabon’s “informal sector”, including street vendors, shoe shiners and home-based workers, who represent 70% of the workforce. The government will have to find new sources of revenue to meet the increasing demands on its health system.
Expanding coverage
“The biggest challenge when you have an ambitious system like this one is sustainability,” said Dr Sambo. “You can have brilliant ideas, but down the road you will find that the system is overwhelmed, you can’t pay anymore, or even if you can pay, the system runs out of money.”
WHO is advising Gabon’s government on ways to build sustainability and contain costs by increasing the use of quality generic drugs and by developing district health plans to expand the provision of primary health care services in rural areas.
Still, further reforms will be needed to contain health costs, including changes to the way goods and services are purchased and measures to encourage patients to use local clinics instead of hospitals, said Dr Barroy.
“The government have not yet put in place mechanisms to manage the increasing demand and expansion of costs,” she said.
“In other countries we’ve seen that this is the biggest challenge. My hope is that Gabon takes this seriously in order to maintain universal health coverage.”
WHO
Labels: Dr. Helene Barroy, Gabon, Health Insurance, World Health Organization