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April 05, 2011

Synergy - not debate - on universal health coverage

Rosann Wisman

At the final session of the African Health Economics and Policy Association (AfHEA) conference held in Senegal earlier this month, Cheikh Mbengue, the Africa Regional Coordinator of the USAID project Health Systems 20/20 led by Abt Associates, offered a compelling way forward amidst an ongoing debate about the respective merits of health insurance and free health care programs.  He said, “There needs to be synergy—and not debate—because the end result remains the same—healthier populations.  It does not have to be “either – or” and African governments have to combine these approaches to reach the objective of Universal Health Coverage. One of the key messages from the participants at the conference is that there’s no conflict between these two approaches.”

The conference theme of, “Moving Toward Universal Coverage,” featured three days of technical presentations and plenary discussion about various health financing approaches.  Participants debated the pros and cons of free care and health insurance approaches.   Free care, or the abolition of user fees, even for narrowly defined populations or services, was talked about as a short-term fix, often implemented without a sustainable, longer-term financing strategy.  On the other hand, free care programs were recognized as promising approaches for increasing the accessibility of important health interventions in targeted and well-defined areas (e.g., C-sections, other reproductive health care or immunizations).

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March 08, 2011

One sentence, months of work

Stephanie Weber

When USAID administrator Rajiv Shah delivered a major speech on global health innovation before the National Institutes of Health earlier this month, one of his first points was the need for countries to have local leadership and ownership of health programs. “We need to improve the efficiency of our efforts and focus on building country-led health systems instead of donor-driven disease control programs,” Shah said.  

In one sentence he brought up an example from Mali, one of MLI’s countries, where remarkable new efficiencies were found in delivering health.

“In Mali, we were able to integrate five separate annual health campaigns into one streamlined program,” said Shah. “The program boosted provision of vitamin A supplements and neglected tropical disease treatments while cutting the cost of delivery in half.”

There is, however, a back story to Shah's story, and it involves a long process of Mali and the United States trying to craft a new type of relationship.

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March 03, 2011

Moving ahead with community health insurance in Africa

Sarah Lindsay

Community-based health insurance has been expanding in sub-Saharan African since the late 1990s.  But its progress has been uneven. The scale-up stagnated in many countries after governments attempted to eliminate the user fees that were blocking the majority of the population’s access to health services. Then, there simply was not enough money flowing into health systems anymore to cover costs.

Cheikh Mbengue, who works as a long-term advisor with a USAID funded program called Health Systems 20/20 led by Abt Associates, told an audience at the Global Health Council on Monday that community-based health insurance remains the most effective avenue to reach people in rural areas. 

Why is it better than traditional health insurance?

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February 24, 2011

Family planning going mainstream

Rosann Wisman

In the efforts to expand access to family planning services in the developing world, victories are often long in coming.

In Mali, officials are nearing a critical point:  Family planning is on the verge of becoming part of standard health insurance benefits packages. 

MLI has been working closely with Mali government leaders at the Ministry of Health and the Ministry of Social Protection to secure family planning as a covered benefit in their mutuelles program, or community based health insurance models.

Cheickna Touré, the Deputy Director of Union Technique de la Mutualité Malienne (UTM) and close MLI collaborator in Mali, emphasized the importance of family planning as part of health insurance programs at the recent West Africa conference, “Family Planning in the context of Population and Development: the Urgency to Act,” held in Burkino Faso.

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December 15, 2010

Mali gains “real momentum toward universal coverage”

Allison Gamble Kelley

In Mali, the barrier to universal health coverage is not political will. The government is determined to scale up and systematize its community-based health insurance programs, or mutuelles. But it lacks adequate technical expertise and capacity for such an ambitious reform,  and yet there is relatively timid donor involvement in health care financing in Mali. Developing a large-scale insurance program involves complex skills, negotiations and institutional reform. That’s where MLI comes in. We’ve been able to connect government officials in Mali with experts who can help them achieve their ambitious goal and mobilize the financial support needed to do it.

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