Why the African model may be the right prescription for India

With cries for universal health coverage echoing at the Africa Health International Conference in Kigali, there are lessons that India could take back home.

Aisha Mukamana holds her one-year-old daughter close to her as she waits for her turn in the vaccination room at the Kabusunzu health centre, 15 km from her home in the Rwandan capital. “I don’t bear any healthcare-related expense. My insurance takes care,” she says.

The Mutuelle de Sante community-based health insurance, offered by the government, provides easy access to primary, secondary and tertiary healthcare. The Kabusunzu centre serves a population of over 28,000 and sees 5,000 patients every month.

Rwanda has 500 health centres at the sector or village-level and 43 district-level hospitals that together cater to the small country’s 12 million population, 84 per cent of whom are fully covered under the government’s community health insurance. The premium is cross-subsidised by the government and higher-income beneficiaries. While those like Mukamana can access services free of cost, people who earn more pay a subsidised consultation fee that averages 200 Rwandan Franc or $0.2.

Multi-pronged approach

At Kigali, African nations were putting their heads together to draw example and other regional success stories from Rwanda to make quality public healthcare a human right. The Africa Health International Conference, held between March 4 and 7, saw the participation of 1,500 stakeholders from across Africa and the developing world.

With the continent’s growing population, mounting healthcare expenses and widening income inequality, the health of a nation has never been in more peril, says Githinji Gitahi, group CEO of Amref, Africa. UHC is the need of the hour.

“The end point of UHC is when an entire population of a country, from the vulnerable to the middle-class and beyond, are covered by a safety net for health. It can’t happen overnight,” says Priya Balasubramaniam, senior public health scientist with the Public Health Foundation of India.

While Kenya is months into a rather successful public health insurance pilot programme that fully covers over 90 per cent of the population in pilot areas, Ghana has improved access to healthcare through subsidised insurance coverage for low-income groups.

Ethiopia has scaled up financial and human resources in health, bettering investment and improving access to achieve UHC. The goal, agreed stakeholders, needs a multi-pronged approach requiring innovative technology and responsive ideas from the private sector.

Six African countries, including Rwanda, have allocated 15 per cent of the national budget towards health; India has still not been able to spare more than 2 per cent. Also, Africa has leap-frogged in using mobile technology.

Uganda’s rapid response technology and early detection systems helped control one of the largest Ebola outbreaks. Rwanda is also using technology apps such as Babyl (which uses artificial intelligence and mobile technology to connect patients with doctors on the phone) and Zipline (which uses drones to deliver crucial medical supplies while overcoming geographic challenges).

Trans-national vision

Last September, Prime Minister Narendra Modi launched Ayushman Bharat scheme, tipped as the world’s largest government healthcare programme, that promises a Rs. 5,00,000 health insurance coverage to 10 crore vulnerable families or 50 crore individuals. Balasubramaniam and others believe that while the scheme itself has been important in putting the spotlight on a much-neglected area of providing substantive health insurance taking a step towards UHC, there are challenges. “Can we create a trans-national vision for UHC that transcends across States,” asks Balasubramaniam.

India invests in technology innovations like DBT (Department of Biotechnology), BIRAC and C-camp that enable health technology.

Indian and the African nations, believes Subramaniam, no longer look at themselves as fragile developing nations.

“There’s a buoyancy in the way these countries are thinking about themselves. If health is a part of that buoyancy to be more successful countries, then UHC is not too far,” sha says.

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The writer was at the Africa Health Agenda International Conference (AHAIC) 2019 in Kigali on the invitation of Global Health Strategies

While Ghana provides subsidised insurance cover, Ethiopia has scaled financial and human resources for universal health coverage