By Adebowale Bello. B.Tech Microbiology. Freelance Health Writer.
A representative sample of vulnerable Africans, the aged, low income families, and children among others.
Across Africa, the fight for universal healthcare remains a pressing concern, particularly for the continent’s most vulnerable populations that include; low-income families, the elderly, women, children and people with disabilities. These groups encounter difficulties in accessing essential medical care. For many, a visit to a clinic means choosing between medical care and meeting basic survival needs.
With health insurance emerging as a transformative tool in many nations, the question arises: how can African governments at different levels bridge the gap between health policies and the realities of their citizens?
All health indices including maternal and infant mortality rates are high even when global rates have gradually declined in the last two decades, thereby highlighting the inadequacies of Africa's healthcare infrastructu
Africa shoulders a heavy burden of preventable infectious and chronic non-communicable diseases. In most nations on the continent, health indices, including maternal and infant mortality rates remain high despite declining nationally and globally in the last two decades. These high indices highlight persistent structural and organizational inadequacies in the health system of most African countries. The World Health Organisation (WHO) reports that Africa accounts for 24% of the global disease burden but has only 3% of the world’s health workers.
For vulnerable populations, the challenges are even greater. Many pregnant women in rural, semi-urban and indeed urban areas lack access to adequate antenatal care, a factor that contributes significantly to the high maternal mortality rate in many African countries. Children under five face preventable deaths from malaria, malnutrition, respiratory and diarrhea diseases, and people with disabilities are often sidelined in healthcare policies. Meanwhile, the elderly, who are mostly dependent on informal support systems, are left with no financial or medical safety net.
Poverty compounds these issues. Out-of-pocket healthcare expenses remain the norm, with families forced to sell assets, crowdfund or go into debt to afford curative healthcare. This not only perpetuates poverty but also undermines trust in government.
While the challenges are stark, there are examples of African countries making strides in addressing healthcare disparities. Ghana and Rwanda stand out as success stories, demonstrating that universal health insurance is achievable with the right policies and political will.
Ghana’s National Health Insurance Scheme (NHIS) introduced in 2003, provides affordable healthcare services to millions including vulnerable populations. The scheme has significantly reduced out-of-pocket expenses and increased access to essential healthcare for the poor and elderly.
Rwanda’s Community-Based Health Insurance (CBHI), with coverage for over 85% of its population, subsidises premiums for the poorest citizens, ensuring that no one is left behind. This inclusive approach has resulted in improved health outcomes and reduced inequalities in healthcare access.
The South African President recently signed its National Health Insurance Act into law in May 2024, with the promise of strengthening the public health sector toward universal health care.
These examples prove that Africa has the capacity to transform its healthcare systems but scaling such successes across the continent requires robust frameworks and commitment.
Nigeria has the potential to replicate or even surpass these successes. With its wealth of resources and a population that demands better governance, the country is well-positioned to create a health insurance system tailored to its unique challenges.
Under the Buhari Administration, the push for health and social insurance legislation was a commendable step forward. The National Health Insurance Authority Act (NHIA) was introduced in 2022. It mandates health insurance coverage for all Nigerians, with specific provisions for vulnerable groups.
The Act also purports to leverage contributions from development partners and NGOs into Nigeria’s Basic Health Care Provision Fund (BHCPF), which has long sought to provide a financial backbone for the underserved.
While the Act allows for coverage of vulnerable populations through a Vulnerable Group Fund (VGF), its implementation remains riddled with challenges that prevent it from delivering on its full promise.
Yet, despite these frameworks, millions of Nigerians—particularly those in rural and impoverished areas—remain without access to basic healthcare services. This is largely due to a gap between policy intent and on-the-ground realities, characterized by poor funding, corruption and lack of awareness about entitlements under the NHIA Act.
Health insurance provides a safety net that protects its enrolled members from catastrophic health expenses while improving access to essential services. To be successful, health insurance is premised on affordable but regular financial contributions from a large pool of people with the promise to provide access to defined health coverage to the few that may need it at any point in time, without financial hardship from additional out-of- pocket spending at the point of care.
There are two main types of health insurance; private and public.
Private health insurance targets the employer (private and public) and union sponsored population, as well as private individuals and families. Many types of private health insurance plans are available.
Public health insurance on the other hand is provided by the government as a part of its social policies and responsibilities. Most proposals for National or Universal Health Insurance as well as vulnerable population targeted insurance schemes like CHIP (Children’s Health Insurance Program), Medicaid and Medicare - all in the United States, fall within the public health insurance category.
For Africa, where poverty and inequality are deeply entrenched, public health insurance can drive social inclusion, equity as well as economic transformation. Healthier populations are more productive, with children attending school regularly and adults contributing to the economy.
Targeted health insurance schemes ensure that the most vulnerable populations—women, children, the elderly, the poor and people with disabilities—are not left behind. They foster a more equitable society where everyone regardless of socioeconomic status have access to quality healthcare.
Given that private health insurance markets do not consider it profitable to provide health coverage to vulnerable populations, and notwithstanding the many criticism of public health insurance programs, valid arguments can certainly be made for vulnerable populations to be given special consideration for healthcare coverage under a public health insurance program.
By addressing healthcare inequalities, governments can reduce social unrest and build trust among citizens. This stability creates an environment conducive to sustainable development.
Despite the clear benefits, the implementation of public health insurance schemes across Africa faces numerous challenges:
To overcome these challenges, African governments, in collaboration with local stakeholders and international partners, must take such decisive action as:
Investing in health insurance for vulnerable populations is not just a moral imperative; it is a strategic decision with far-reaching benefits. A healthier Africa means stronger economies, reduced inequalities and a brighter future for millions.
Countries like Ghana and Rwanda have shown the way. Now, the challenge lies in scaling these successes across the continent. For Africa, the path forward is clear: universal health insurance that leaves no one behind. This is not merely about policies or budgets—it is about justice, equity and the recognition of healthcare as a fundamental human right for all including vulnerable populations.
Published: December 19, 2024
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