Funding universal health coverage

Covid-19 has reminded me of the story of Honduras’ bridge to nowhere. 

A story is told of River Choruteca, where annual floods used to wash away the bridge periodically.

Given the recurrent problem, people had to sit down and reconstruct a new bridge to solve the problem.

The Japanese-designed Choruteca Bridge was a marvel to withstand the floods. However, the problem it was designed to deal with changed entirely because the river had changed its course.

The river no longer passed under the bridge; hence, it came to be known as the bridge to nowhere–obsolete and a waste. 

The bridge can be likened to Malawi’s health policies.

Our long-serving systems are outdated and the Covid-19 pandemic may change the course of the health problems entirely.

In terms of health policies, a number of health reforms have been debated since 2014. These include the introduction of fees for health services in some selected facilities and  national health insurance.

These reforms were also stipulated in some party manifestos for the June 23 Fresh Presidential Election won by President Lazarus Chakwera.

The idea behind the policies is to ensure Malawi attains universal health coverage (UHC), which requires everyone to access quality healthcare services without experiencing the costs that would push them into poverty. 

There has been some rhetoric that healthcare is free in Malawi.

However, evidence shows that although people access partially free services, there are a lot of health care inequalities.

Now, as donations may decline as donors deal with  Covid-19 effects in their countries, how do we finance our health system without much aid?

What sort of health financing mechanism do we adopt?

UHC proposes introducing a prepaid model that has been on the agenda, even in the current national health policies.

UHC does not mean free healthcare.  Even the World Health Organisation (WHO) recognises that healthcare cannot be provided for free. There is a cost.

Since 2014, there have been numerous meetings on the introduction of health insurance, user fees or tax-based financing.

Each of these has its own problems.

WHO recommends a combination of these strategies.

Each country has to tailor its own solutions.

However, some of these issues could have come out in the newly passed budget.

A quick run through the 2020/21 Budget shows an interesting trend.

Healthcare has been allocated K204.7 billion, representing 11.5 percent of the budget. This is despite the Abuja Declaration urging governments to allocate at least  15 percent of their national budgets to health. 

The Covid-19 presents a great challenge to attain UHC.

It is likely to destroy the gains made in health sector over the past years. 

This calls for prepaid forms of health financing to supplement the budget as healthcare spending still relies heavily on donors.

As other countries such as Rwanda and Ghana have demonstrated that  a well-coordinated community-based health insurance may in fact supplement government spending.

It does not raise a lot of funds, but it creates the mindset of ownership and funds to the national purse.

It is a way to make people start walking on their feet and slowly get out of the shackles of donations. 

Rwanda provides an awakening. The country, which was ravaged by genocide and much poorer than Malawi in 1994, rolled out community-based health insurance in 2005.

Currently, the insurance scheme has a membership of between 70 and 90 percent.

Health insurance may not benefit our current generation, but the future. 

In times of emergencies such as Covid-19, it could have formed a good source of risk allowances for the health personnel in areas where it would be in operation. 

But given the budget passed by Parliament this month, where is UHC financing heading to? 

We may soon be another Cholurteca Bridge—the bridge to nowhere.