Analysis: FREDERICK CHITANGALA
ON APRIL 9, 2018, The National Health Insurance Bill was assented to and became law; Act No. 2 of 2018. With this law, there is established the National Health Insurance Scheme to provide universal access to quality insured health care services in accordance with the Act. Consequently, every citizen or established resident who is above 18 shall be registered as a member of the scheme in the prescribed manner and form, whether poor, vulnerable, unemployed or in employment. This is what is called social health insurance (SHI). You want to know why this is needed and how it should work? I will explain but first, you must understand how SHI will assist us reach Universal Health Coverage (UHC) goals.
If you are employed and you have an above average income, you are probably one of the few that do not struggle to access and utilise promotive, preventive, curative, rehabilitative and palliative health services. Unfortunately, majority of Zambians are unable to access health care because they cannot afford it. This has since become the basis on which universal UHC was idealised. In fact, according Dr. Margaret Chan, the then WHO’s Director General, universal health coverage is the single most powerful concept that public health has to offer.
However, in order to attain UHC goals, we need to demonstrate good governance, sound systems of procurement of medicines, medical technologies, and well-functioning health information systems. In short, a strong health system is required for achieving Universal Health Coverage. Nevertheless, we need to mobilise resources which will not disadvantage some households.
The best resource mobilisation is done through health insurance rather than having people pay from their pockets. And that’s how come social health insurance (SHI) has become an alternative to reducing an important barrier to access for those who need coverage the most. It is a powerful mechanism for improving equity within the covered population and it is a means by which financial protection is attained.
So how does SHI work?
There will be pooled health risks for which you will be covered. You will be required to make an annual contribution towards the scheme in order for your household to access the covered services. With SHI, we can guarantee cross-subsidisation where the rich, the healthy and the young are able to share the burden of both health risks and costs with the poor, sick and elderly respectively.
The advantage is that should you or any member of your household fall ill, you will not have to worry about how much you have in your pocket. Just get your scheme card and visit any accredited health facility near you. They will attend to you and you won’t have to worry about paying.
Is our SHI technically and financially viable?
The answer to this question depends on the depth and height of coverage. Depth refers to the array of services that will be available while height refers to the ratio of the total cost covered by insurance. Many countries have established an “essential package”, which should be covered. But we are not yet sure what our essential package will be. Like any other country, the funds available are never enough hence choices will have to be made and priorities set. Therefore, we expect the essential package to reflect what will provide the biggest health benefit to the population for the least cost. So don’t expect all health risks to be covered, only those which are essential.
Until last year, Zambia did not have a standalone policy on health insurance and there was no explicit reference to health insurance in the current law, the Insurance Act, No. 27 of 1997. The National Health Insurance Act No. 2 of 2018 provides for, inter alia, establishment of the National Health Insurance Management Authority (NSHIMA).
Okay, now we can look forward to a Zambia where every person living within our boundaries is protected from financial ruin and that this does not incapacitate them from accessing health care. But for SHI to function properly as intended in the law, certain conditions must be present.
First, levels of income and the percentage of the population employed in the formal sector of the economy must exhibit growth or at least there must be deliberate programs on the part of government to create a fund to cover the unemployed and those in the lower income brackets.
Secondly, the national banking system must be efficient to facilitate the flow of funds and information. At least our banking system has experience in handling e-vouchers and social cash transfers.
Thirdly, a high degree of integrity and probity in corporate and public affairs is needed, because this will require handling greater amount of funds. The National Health Insurance Act is very clear on this expectation. For now, we can smile because we have equity in health care. This is the Zambia we want.
(Look out for the next article on the expected challenges of SHI in Zambia).
The author, a public health and strategic planning consultant, is director at the Olympic Youth Development Centre.
Analysis: FREDERICK CHITANGALA