Gabon Gets Everyone under One Social Health Insurance Roof: Gabon's Comprehensive Health Insurance System Is Attracting Virtually All of Its Citizens, but to Be Sustainable It Will Need to Get Costs under Control
2013; World Health Organization; Volume: 91; Issue: 5 Linguagem: Inglês
ISSN
1564-0604
Autores Tópico(s)Healthcare Systems and Practices
ResumoMichel Mboussou, who heads Gabon's National Health Insurance and Social Welfare Fund, has every reason to be a happy man. During his tenure, as director-general of the Caisse Nationale d'Assurance Maladie et de Garantie Sociale (CNAMGS) in this Central African country, he has seen the steady extension of health-care coverage to the country's different socioeconomic groups, bringing everyone under one social health insurance roof. When the CNAMGS was launched in 2008, it started to extend coverage to Gabon's poorest people, including students and the elderly. In 2011, coverage was extended to public sector workers. This year it has started providing coverage to private sector workers, previously covered by the Caisse Nationale de Securite Sociale (National Social Security Fund), which is being wound down. We began registration of private sector workers in March and the process will probably be completed this year, says Mboussou. When Gabon finally completes the last phase in the roll-out of social health insurance--expected to happen this year or next--it will be a major step towards bringing to a close four decades of hit-and-miss attempts to meet the health needs of the country's 1.5 million people. [ILLUSTRATION OMITTED] At independence in 1960, the government pledged to make health care available to all citizens free of charge at the point of access, but health-care provision for the poor remained inadequate. Such efforts were spurred globally by the health-for-all declaration in 1978 and, most recently, in 2011, when countries pledged to increase access to health care and decrease out-of-pocket payments as they move towards universal health coverage. In Gabon, the poor were initially slow to take up the chance to be covered by social health insurance but, by 2011,417 118 of them--just short of the 546 125 eligible beneficiaries identified in a 2008 national census--were signed up. It seemed too good to be true. At first, people didn't believe that they would be looked after, says (not her real name), a 20-year-old student at Omar Bongo Ondimba University in the capital, Libreville. But things have changed now because there has been a lot of publicity and, also, because people talk to each other, she explains. For her part Elodie has told all her friends about some dental work she had done. procedure would have cost CFA 90 000 (US$ 180), but I paid only CFA 15 000. Extending coverage to the poorest members of society is something that low-and middle-income countries struggle to do, especially in sub-Saharan Africa. So far, only a few countries in Africa have achieved anything like the same coverage level through a social health insurance scheme. Ghana, for example, is funding its system with a 2.5% value added tax, insurance premium payments and a top-up subsidy from government funds. Gabon funds health-care coverage for its poor from a 10% levy on mobile phone companies' turnover, excluding tax, and a 1.5% levy on money transfers outside the country. The levies are known collectively as the redevance obligatoire a l'assurance maladie (ROAM) or mandatory health insurance levy. These levies have been a tremendous success, says Dr Inoua Aboubacar, a public health specialist at the World Health Organization (WHO) Country Office in Gabon, pointing out that overall resources for the CNAMGS (pronounced knam-jay-ess) almost quadrupled from CFA 12.5 billion (US$ 25 million) in 2008 to just over CFA 47 billion in 2011, of which CFA 17.5 billion were via this levy system. It was largely because of these levies that we were able to start extending social health insurance to poor Gabonese, explains Mboussou. Another reason was that since previous attempts to cover the poor had largely failed, the CNAMGS was starting from an institutional clean slate. Transferring public sector workers from the Caisse Nationale de Garantie Sociale (National Fund for Social Protection) before liquidating the fund was also relatively straightforward, since it was a separate, functional unit and, of course, government run. …
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