HUMAN MATTERS: Readiness key in universal health plan

On Sunday next week, Tanzania and other countries will mark World Health Day (WHD).

This is a global health awareness day sponsored by the World Health Organization (WHO), and celebrated on April 7 of every succeeding year, beginning in earnest in 1950 (incidentally, April 7 is also Karume Day in Tanzania to commemorate the legacy of Abeid Amani Karume, the first president of Zanzibar and first Vice President of Tanzania who was assassinated on April 7, 1972).

The 2019 WHD focus is on the growing movement towards health coverage for all, formally known as Universal Health Coverage (UHC). In my view, it’s important that WHD critically looks at what drives people to access healthcare services.

People’s readiness to take up healthcare is a pertinent issue because – as the UHC campaign picks up pace – questions are being raised about the quality of healthcare products and services and whether or not there is significance in what is being campaigned for.

In Tanzania, the government is leading a campaign to encourage people to join health insurance schemes so that they can more readily access healthcare products and services. Currently, only about 30 per cent of the population (of around 55 million people) has health insurance cover, according to data from the Health ministry.

In the event, some 38 million or so Tanzanians have to dig deep into their near-empty pockets to pay for healthcare.

Health Minister Ummy Mwalimu has always reiterated the government’s intention to expand health insurance coverage to 50 per cent of the population by 2020.

If the campaign to encourage more people to take up health insurance gains ground, then the demand for quality medical products and services would predictably rise. Indeed, lessons can be drawn from studies on what people think about health insurance.

Four years ago, researchers conducted interviews with informal sector players in the four administrative districts of Singida, Mbulu, Kigoma and Kilosa-Rural on the challenges they faced in seeking to enroll with the Community Health Fund (CHF). This is a health insurance scheme that targets the informal sector in rural Tanzania to encourage voluntary membership.

Results of the survey – titled Determinants of Community Health Fund Membership in Tanzania: A Mixed Methods Analysis – indicated that to successfully promote health insurance needed huge investments and a tactical approach.

Firstly, the researchers found that many people did not understand the CHF concept. For instance, some believed that their contributions were actually savings which would be returned to them if they did not fall sick and secure medical attention!

One person who was interviewed queried as follows: “Why should I pay again for the next year when neither I nor my dependents fall sick this year? I didn’t use the money I paid to the Fund!”

But, most importantly – which is in fact the gist of this article – is another finding by the researchers. Many dispensaries that were associated with the Community Health Fund were found to have no diagnostic equipment. This resulted in people having to go to high-level/referral public or private medical facilities not covered by health insurance schemes.

“Sometimes, they (medical facilities) don’t treat what was supposed to be treated at the dispensary, because they don’t have the requisite diagnostic equipment,” one polled person told the researchers.

Indeed, we are seeing ongoing efforts by the government to promote an improved CHF version. But, generally speaking, the processes of covering every Tanzanian under health insurance require bona fide political will and bold decisions that are based on sound economic principles – not on mere rhetoric and highfalutin campaigns.

To borrow the words of WHO Regional Director for Africa, Dr Matshidiso Moeti: “We must recognise the specific needs of the region, and prioritise an innovative services delivery approaches that result in a long-term impact – and lead to our common goal of quality healthcare for everyone, everywhere.”

Clearly, achieving UHC is not only about expanding access to essential medical products and services. It is also about vastly improving their quality – and ensuring that people are willing, able and ready to access them.

There are several underlying factors that often result in poor health. These include – but are not limited to – abject poverty, malnutrition, ignorance, poor water and sanitation services, as well as climate vulnerability, and lack of political and social rights.

These have to be addressed, too.

The author is a health journalist with The Citizen