Striving for a better healthcare

By Mikias Sebsibe

One of the most remarkable achievements of the Ethiopian government is undoubtedly in the area of health coverage. The Ministry of Health (MoH), spearheaded by Dr. Tedros Adhanom who was dubbed ‘The best health minister in the World’ by former US President George W. Bush, is at the center of all the achievements.

In order to expand health coverage and improve the delivery of primary health care service, the Ministry has been implementing the famed Health Extension Program (HEP). The government has also been actively working on the construction of new health facilities as well as upgrading and equipping existing ones.

Hence the government remains focused in improving the health status of citizens from the supply side – by improving physical access to health care and quality in health service delivery. However on the demand side, at the household and individual level, the groundwork is just being laid out.

Some 85 percent of Ethiopians live in the rural areas. Engaged in subsistence farming or pastoralism, this vast community relies on a meager daily income. The health service-seeking behavior of the community is limited, as they are required to pay out-of-pocket when they visit health facilities at the time of sickness. This puts a barrier on access to health. This prompted the government to introduce health insurance coverage in Ethiopia.

In August 2010 the House of Peoples Representatives (HPR) ratified the Social Health Insurance Proclamation, which aimed at enabling all the working society and pensioners to get a health insurance. This law, when it goes operational, could provide health insurance scheme for up to nine million people. The number includes employees of both private and public institutions and their spouse as well as children under the age of 18.

The strategy devised by the government hopes to finance the insurance scheme on a cost-sharing basis. According to a draft regulation, which is awaiting the council of ministers’ approval, both employers and employees are required to contribute three percent of a worker’s salary. The contribution is put at one percent for pensioners.

Three percent of one’s salary for healthcare seems to be a pretty good deal for an individual, but on a government level the cost is much higher. The scheme could force the government to fork out billions of birr annually. This includes the establishment of an agency with branches in regional states. The agency’s administrative budget is fully covered by the government. This is indicative of the government’s political commitment to ensuring health coverage for all.

Perhaps what gives the country’s Health Insurance Strategy a more universal approach is the Community-Based Health Insurance. This scheme caters for the rural poor informal sector, which comprise the vast majority of the country’s population. Currently a pilot project is underway in 13 weredas of the Amhara, Oromia, Tigray and SNNP regions.

A member of a certain community would contribute a certain amount of money per month at a wereda level. Then, the  members could benefit from a provision of essential health service packages at the health center level. The scheme is receiving encouraging reviews from public dialogues conducted, according to experts involved in the process.

Ethiopians are familiar to long established socio-economic fabrics. The practice of Iqub and Idir are examples in this regard. Take Idir, for instance, where every households of a neighborhood contributes every month a certain fee for occasions like funeral. Even those with a very low income take part in this social set up and rip the benefits from it. If the Community-Based Health Insurance is to become successful, then Ethiopia is the ideal country. This long established set up has promoted solidarity, mutual aid and reciprocity over the years. But what’s vital is that the Idir must assure its worth to the community. The same should be the focus of the health insurance scheme of Ethiopia. It must assure adequate health service for citizens. For that to happen, the groundwork has to be carried out carefully.