Why extending health protection to rural poor important

By Christian Gaya: Business Times Friday January 4-10, 2013

The absence of affordable health care in the country contributes to millions of Tanzanians falling into poverty each year. This being so, how to better finance health protection for all is a policy issue on the rise. Nowhere is this challenge more pronounced than in Tanzania and other developing countries, and it is with regards to these countries that the need for the sharing of good practice remains greatest.

Health protection is increasingly seen as a key strategy to contribute to poverty reduction and to sustainable development. But in Tanzania, where the informal economy sector remains huge and where poorly effective risk management strategies often prevail, there still is a long way to go. Community health insurance under National Health Insurance Fund, however, appears to be an interesting option for meeting the goal of universal social protection. There is convincing evidence of its positive effect on access to health care. Moreover, community health insurance constitutes a promising channel to give voice to the poor Tanzanians. Today, this particular instrument of social health protection reaches only a small fraction of the Tanzanian population, but enjoys a growing acceptance and is subject to increasing demands.

Health protection has become one of the hottest issues on social policy agendas. Considering international commitments to realize global improvements in health levels, not least to help combat poverty, this is not surprising. Another issue is the increased risk of ‘new’ global health pandemics such as avian flu, while ‘old’ communicable diseases like cholera, yellow fever and tuberculosis continue their creeping return.

But regardless, affordable health care remains inaccessible to the majority of the Tanzanian’s population. As one measure of the challenge, it is estimated that 20 million people in the country a year fall into poverty because of inadequate access to affordable medical treatment.

Beyond the human cost, the economic cost of underdeveloped health systems is also considerable: For example, by 2020, in African countries with the highest levels of HIV/AIDS prevalence, national income growth targets may fall short by 20 per cent.

But despite a growing awareness of the importance of improving health in the country, many practical challenges remain with regards to extending access to health protection the urban and rural poor.

Key policy issues for Tanzania as a developing country should mainly relate to identifying the minimum package of health care benefits that should be provided to her population, should also focus on choosing the financing model(s) to be used, and ensuring the necessary institutional infrastructure and human resources to enable benefits to be efficiently and effectively delivered.

It should be understood that the amount spent on health and the manner in which it is financed is often influenced by a country’s level of development. In general, the richer a country the more it will spend. On average, high-income countries spend about 10 per cent of GDP on health, middle-income countries spend 6 per cent, while low-income countries spend less than 5 per cent.

It is estimated that most low-income countries spend less than US$34 per capita on health, the World Health Organization’s recommended minimum annual spending target for essential interventions. A related issue is achieving a more equitable distribution of resources. In Tanzania as a country, it shows that a great deal of the available funds for health protection is often allocated to specialist facilities in urban and large cities leaving the majority rural poor unprotected. This being so, the primary health care priorities of the majority often remain under-financed.

And international aid offers no panacea either; available donor finance is often tied to programmes for specific diseases, such as Tuberculosis, Malaria, and HIV/AIDS. Therefore, the possibility of financing treatment for other medical conditions is excluded.

Consequently, for lower-income rural poor groups, out of-pocket payments play a major role and may represent more than 60 per cent of total health spending. This contrasts with a figure of around 20 per cent in high-income urban and large cities. It is widely agreed that out-of-pocket spending on health disadvantages the majority lower-income groups. It may even lead individuals to not seek or to discontinue treatment, thus possibly aggravating a medical condition that may then require more complicated or expensive treatment.

And the resulting incapacity that may arise may also lead to a loss of earning capacity. Inevitably for many developing countries like Tanzania, with limited tax raising opportunities and with international aid not always sufficiently targeted on the priority needs of recipients, finding the required finance is difficult.