Health Insurance In Africa Research Articles

Three Ethical Issues in the Development of Public Genetic Health Policies in Africa

It is of paramount importance that sensible and prudent public policies for the introduction and management of genetic research, technologies and therapies be adopted for countries on the African continent. The author agrees with Buchanan et al. when they claim that it is “unwise to consider the ethics of genetics only at the individual level. What matters is not merely the ethics of the individual scientist, physician or counsellor, but the broader questions of justice, of claims for freedom and for protection from harm, and our obligations towards future generations”. What is therefore important, is the development of a “public and institutional policy on genetics” (Ibid.) that is adopted for the needs of, specifically, the people of Africa. The author delineates three such issues, and indicates some moral aspects that accompany their understanding as well as the challenges that they pose. The three issues are: (i) The kinds of genetic technologies that are appropriate for African needs, (ii) The lessons about public health policy to be learned from (especially South African) policymakers’ appropriation of scientific expertise, (iii) Concerns about informed consent of patients and the competence of health care professionals in administering appropriate genetic remedies in African societies

The impact of health insurance in Africa and Asia: a systematic review

To evaluate the impact of health insurance on resource mobilization, financial protection, service utilization, quality of care, social inclusion and community empowerment in low- and lower-middle-income countries in Africa and Asia. A systematic search for randomized controlled trials, quasi-experimental and observational studies published before the end of 2011 was conducted in 20 literature databases, reference lists of relevant studies, web sites and the grey literature. Study quality was assessed with a quality grading protocol. Inclusion criteria were met by 159 studies - 68 in Africa and 91 in Asia. Most African studies reported on community-based health insurance (CBHI) and were of relatively high quality; social health insurance (SHI) studies were mostly Asian and of medium quality. Only one Asian study dealt with private health insurance (PHI). Most studies were observational; four had randomized controls and 20 had a quasi-experimental design. Financial protection, utilization and social inclusion were far more common subjects than resource mobilization, quality of care or community empowerment. Strong evidence shows that CBHI and SHI improve service utilization and protect members financially by reducing their out-of-pocket expenditure, and that CBHI improves resource mobilization too. Weak evidence points to a positive effect of both SHI and CBHI on quality of care and social inclusion. The effect of SHI and CBHI on community empowerment is inconclusive. Findings for PHI are inconclusive in all domains because of insufficient studies. Health insurance offers some protection against the detrimental effects of user fees and a promising avenue towards universal health-care coverage.

An assessment of mental health policy in Ghana, South Africa, Uganda and Zambia.

BackgroundApproximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia.MethodsThe WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached.ResultsAll four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities.ConclusionsSix gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.

Equity and health policy in Africa: using concept mapping in Moore (Burkina Faso).

BackgroundThis methodological article is based on a health policy research project conducted in Burkina Faso (West Africa). Concept mapping (CM) was used as a research method to understand the local views of equity among stakeholders, who were concerned by the health policy under consideration. While this technique has been used in North America and elsewhere, to our knowledge it has not yet been applied in Africa in any vernacular language. Its application raises many issues and certain methodological limitations. Our objective in this article is to present its use in this particular context, and to share a number of methodological observations on the subject.MethodsTwo CMs were done among two different groups of local stakeholders following four steps: generating ideas, structuring the ideas, computing maps using multidimensional scaling and cluster analysis methods, and interpreting maps. Fifteen nurses were invited to take part in the study, all of whom had undergone training on health policies. Of these, nine nurses (60%) ultimately attended the two-day meeting, conducted in French. Of 45 members of village health committees who attended training on health policies, only eight were literate in the local language (Moore). Seven of these (88%) came to the meeting.ResultsThe local perception of equity seems close to the egalitarian model. The actors are not ready to compromise social stability and peace for the benefit of the worst-off. The discussion on the methodological limitations of CM raises the limitations of asking a single question in Moore and the challenge of translating a concept as complex as equity. While the translation of equity into Moore undoubtedly oriented the discussions toward social relations, we believe that, in the context of this study, the open-ended question concerning social justice has a threefold relevance. At the same time, those limitations were transformed into strengths. We understand that it was essential to resort to the focus group approach to explore deeply a complex subject such as equity, which became, after the two CMs, one of the important topics of the research.ConclusionUsing this technique in a new context was not the easiest thing to do. Nevertheless, contrary to what local organizers thought when we explained to them this "crazy" idea of applying the technique in Moore with peasants, we believe we have shown that it was feasible, even with persons not literate in French.

Editorial: A view from beneath: Community Health Insurance in Africa

This paper presents an overview of the development of Community Health Insurance (CHI) in sub-Saharan Africa. In 2003, nearly 600 CHI initiatives were registered in a dozen countries of francophone West Africa alone. At regional level, coordination networks have been created in Africa with the aim to support and monitor the developments of this innovative model of health care financing. At national level, governments are preparing the necessary legal frameworks for CHI implementation. CHI is increasingly seen as a strategy to meet other development goals than only health. It constitutes an interesting model to finance health care, to pool financial resources in a fair way and to empower health care users. The CHI movement however still faces many challenges. The relevance of more professional inputs in the management of CHI and the need for careful subsidy of CHI schemes are increasingly recognized. There is also need to optimize the relationship of CHI with the other actors in the health system and to scale-up CHI so as to gain in effectiveness and efficiency. The boom in the number of schemes in Africa during the last years is an indicator of the increasing attractiveness of the model. In practice however, enrolment rates per scheme remain low or are only slowly increasing. Context-specific research is needed on the reasons that prevent people from enrolling in larger numbers. On that basis, relevant action to be taken locally can be identified.

Health insurance in rural Africa

The authors of the 1993 World Development Report "Investing in Health," along with other international health professionals, believe rural health insurance in Africa to be unfeasible. However, this belief excludes from the policy debate the option of allowing rural households to make direct financial contributions to the cost of their health care without placing financial barriers to obtaining care at the time of the illness. These detractors suggest that patients pay clinic and hospital fees for consultations and treatments provided in government facilities. Such fees, however, will deter many rural patients, mostly children and women, from seeking health care. The notion that health insurance schemes for rural populations in Africa would not be feasible seems to be based upon assumptions that there is neither preference nor demand for health insurance among these populations, and that schemes would require management structures similar to those of Western health insurance systems. There is little evidence for either contention. Supporting case examples are given from Burundi and the Gabu region of Guinea Bissau.

Structural adjustment and health policy in Africa.

World Bank/International Monetary Fund Structural Adjustment Programs (SAPs) have been introduced in over 40 countries of Africa. This article outlines their economic policy measures and the experience of the countries that have introduced them, in terms of nutrition, health status, and health services. The evidence indicates that SAPs have been associated with increasing food insecurity and undernutrition, rising ill-health, and decreasing access to health care in the two-thirds or more of the population of African countries that already lives below poverty levels. SAPs have also affected health policy, with loss of a proactive health policy framework, a widening gap between the affected communities and policy makers, and the replacement of the underlying principle of equity in and social responsibility for health care by a policy in which health is marketed commodity and access to health care becomes an individual responsibility. The author argues that there is a deep contradiction between SAPs and policies aimed at building the health of the population. Those in the health sector need to contribute to the development and advocacy of economic policies in which growth is based on human resource development, and to the development of a civic environment in Africa that can ensure the implementation of such policies.

Violence, conflict and health in Africa

This study attempts to examine the impact of incessant violence and political conflicts on the development of health services in Africa. Specifically, how do violent activities and conflicts, such as wars, affect health care infrastructures and health policies in Africa? The paper further examines the consequences of violence and conflicts on the health of refugees. The paper concludes that African states would develop better health policies for their citizens in the absence of violence and conflicts.

Health policies in Africa and Latin America: Adopting the primary care approach

The central problem of this special issue of Social Science and Medicine is: why and how governments adopt (or fail to adopt) the primary care approach to health care delivery. The papers approach this problem from different perspectives, including the international arena, economic and social constraints, regime and institutional characteristics, and development projects. Recommendations for changing health policy are also reviewed, leading to the conclusion that more research into the process of policy-making is necessary.