Developing countries: Universal Healthcare Insurance takes shape

Universal Healthcare Insurance (UHI) or health insurance, financed by the state, employers and possibly by private individuals, was long regarded as unattainable in developing countries. Unlike pensions, industrial accident insurance or free public schooling, this was not part of the colonial legacy bequeathed to the newly independent African or Caribbean states in the 1960s and 70s. Indeed, even in a former colonial power such as France it was not introduced until after the Second World War.

Some form of free medical care was nevertheless provided in most of the newly independent countries, but from the 1980s this minimum began to fray. It was not until the mid-1990s in the Caribbean and the first decade of this century in Africa that plans to provide universal medical coverage were given serious consideration. In sub-Saharan Africa, with the exception of South Africa, Ghana was first off the mark in 2003 with guaranteed access to health care for all, especially primary care, with no obligation to pay on the spot at medical centres. Although the lack of hospitals, equipment and personnel prevented the system from fulfilling its mission in full, it did serve to encourage private investment in the health sector and aid from institutional donors. The system grew stronger.

Mauritania, Mali and Gabon began to introduce health cover at the start of 2007. Four West African countries, namely Benin, Burkina Faso, Ivory Coast and Senegal, are currently preparing their systems.

In the Caribbean, five territories benefited from health insurance quite early on. First Bermuda (UK) from 1971, Antigua (UK) in 1978 (before its independence in 1981) and then Surinam in 1981. These were followed by the Cayman Islands (UK) in 1997 and Aruba (Netherlands) in 2001. In all these cases the UHI provides a limited number of services.

In 1994, Trinidad &Tobago adopted a framework law with provisions to introduce universal healthcare insurance. It is still being introduced today, in stages. Several other countries in the region are now also developing their own systems, namely Jamaica, St Vincent & the Grenadines, the Bahamas, Saint Lucia and the Dominican Republic. The latter already has a “social insurance service” that covers workers for whom employers pay a contribution, but not the whole population. Cuba is a special case as the state, in theory, bears the full cost of health care.

In the independent Pacific Islands, members of the ACP group, the state generally guarantees free primary care at least. This includes medical tele-consultations by computer in the Solomon Islands, essential given the “dictatorship of distances” that penalises countries made up of islands that are very remote from one another. Fiji is considering introducing a genuine system of universal medical coverage in the near future.

Hegel Goutier