With all of the talk of healthcare (specifically, Medicare) reform going on this election season, it is interesting to note that abroad, reform is also being discussed just as avidly … in developing countries. Later this week, the African nation of Rwanda will be hashing that issue out. The Conference on Social Health Protection in the East African Community will begin and will also consider the wisdom of similar initiatives in other nations; Uganda, Tanzania, and Kenya will also begin discussion.
Dr. Ernst Spaan, one of the authors [of a WHO study on the need for such delivery of healthcare], said, “There is a lot of debate going on on how to finance health services in developing countries. In Asia and Africa there is a lot of debate on should they focus on social health insurance or community-based health insurance? And we actually looked into that and we found out there are a lot of studies, but it’s a bit patchy. So we decided to do a systematic review of the literature.”
That financing for social healthcare, as it’s called, is based upon many factors not dissimilar to ones commonly cited in the United States by proponents of a single payer mechanism — how much coverage certain sectors of the population will obtain in a federally subsidized manner, along with how that federal subsidy is paid for.
“That of course poses a problem in many developing countries because of the fact that the informal sector is quite large. Sometimes even 60 percent of the population or higher is not in formal employment. Also because of the large agricultural sector income is dependent on harvest times, so it’s also very erratic,” said Spaan.
It remains to be seen just how adoption of a system like a single payer would occur in nations like Rwanda. Whether it’s a no-brainer or an issue that raises concerns of inequality among socio-economic classes will be interesting points of reference as the conference gets under way.