The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda

Chemouni, Benjamin

doi:10.1016/j.worlddev.2018.01.023

Cited by 155 publications

(164 citation statements)

References 29 publications

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“…26 In Africa, the governments in Ghana and Rwanda have introduced such mandatory schemes. [27][28][29] The Senegalese government has opted for an approach to gradually progress towards a mandatory scheme, for example by requiring new members of professional guilds to enrol in a community-based health organization. 30 Another issue is that public sector engagement to expand the insurance coverage is still weak in the country.…”

Section: Discussionmentioning

confidence: 99%

“…In Rwanda, achieving a high coverage rate is one of the performance indicators of local governments, incentivizing the public sector to be actively involved in the insurance scheme. 28,31 The on-going reform in Senegal of transferring the risk pooling from community level to department level is expected to reduce fragmentation of the health financing system. [32][33][34][35] The integration of the free health-care initiatives into the community-based health in-surance scheme, should also contribute to reduce fragmentation of the health financial protection schemes.…”

Section: Discussionmentioning

confidence: 99%

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Reforms for financial protection schemes towards universal health coverage, Senegal

Daff

Diouf

Diop

et al. 2019

Bull. World Health Organ.

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Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, la Couverture Maladie Universelle. One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reforms for financial protection schemes towards universal health coverage, Senegal

Daff

Diouf

Diop

et al. 2019

Bull. World Health Organ.

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“…This process represents a continuum through which countries with UHC plans move through in stages (Bennett et al. ; Chemouni ; WHO ).…”

Section: Discussionmentioning

confidence: 99%

Inequalities in the Age of Universal Health Coverage: Young Chileans with Diabetes Negotiating for Their Right to Health

et al. 2019

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While universal health coverage (UHC) has been praised as a powerful means to reduce inequalities and improve access to health globally, little has been said about how patients experience and understand its implementation locally. In this article, we explore the experiences of young Chileans with type 1 diabetes when seeking care in Santiago, within Chile's UHC program, which sought to improve people's access to health care. We argue that the implementation of UHC, within a structurally fragmented health system, did not lead to the promised equitable health care delivery. Although UHC aimed to equitably provide universal care, locally it materialized in heterogeneous configurations forcing individuals into positions of precarity and generating new inequalities. Furthermore, for the young people in the study, UHC intersected with their health insurance and socioeconomic status, impacting on the health care they could access, consequently making diabetes care and management a difficult challenge.

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“…There is a shift from fragmentation to coordinated, collaborative partnerships. [16] 2. The introduction of national health insurance schemes should be phased in for resilience during economic downturns, and only scaled up during expansionary phases.…”

Section: People-centric Health Services Delivery Through Universal Hementioning

confidence: 99%

“…Rwanda mainly provides UHC to poor citizens in the informal sector through community-based health insurance with the highest enrolment in sub-Saharan Africa (SSA) of ≈87%. [16] Other SSA countries lag in health insurance enrolment and have varying success: Gabon with 45%, Ghana with 38%, Senegal with 32%, Burundi with 25%, Namibia with 18%, Botswana and Kenya each with 17%, South Africa with 16%, Tanzania with 10%, Ethiopia with ≈8%, Nigeria with 3%, and Lesotho with 2%. [16]…”

Section: People-centric Health Services Delivery Through Universal Hementioning

confidence: 99%

Sustainable Development Goal Integration, Interdependence, and Implementation: the Environment–Economic–Health Nexus and Universal Health Coverage

Cerf

2019

Global Challenges

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The sustainable development goals (SDGs) are interdependent and integrated. The SDGs aim to impact all levels of society, reach across all sectors, embrace equity, inclusion, and universality, and operate in an ecosystem. SDG 3 strives to improve health outcomes by reducing mortality, ending epidemics, preventing diseases, and implementing universal health coverage (UHC) for accessible, affordable, quality, and equitable healthcare. The available infrastructure (environment) should be supportive and sustained by a stable, growing economy (economy) to ensure the timely and reliable delivery of quality healthcare (health). A general framework is presented for the implementation of the SDGs with a focus on SDG 3 and one of its targets, UHC. The robustly aligned environment–economic–health nexus is a key determinant for the successful implementation of UHC (and the SDGs). SDG implementation presents multiple convoluted challenges at national, regional, continental, and global levels but will ultimately yield rewards. To advance UHC, a global effort is required where timely information is shared and nations partner to achieve this important global health target. Especially in low‐ and middle‐income countries (LMICs), the learning and sharing of experiences and knowledge are essential throughout the course of implementation. This will ensure that no nation is left behind.

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The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda

Cited by 155 publications

References 29 publications

Reforms for financial protection schemes towards universal health coverage, Senegal

Reforms for financial protection schemes towards universal health coverage, Senegal

Inequalities in the Age of Universal Health Coverage: Young Chileans with Diabetes Negotiating for Their Right to Health

Sustainable Development Goal Integration, Interdependence, and Implementation: the Environment–Economic–Health Nexus and Universal Health Coverage

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