The Role of the Private Sector in Health Financing Strategies towards UHC in Africa

Co-authored article by Elena Konzourova-Graeff, Head of Public-Private Partnerships, Business Development Life & Health Reinsurance (ME&Africa) Axa France, and Mrs Marloes Kibacha, Managing Director, Africa Health Business

Universal Health Coverage (UHC) has been globally defined as; “all people receiving quality health services that meet their needs without exposing them to financial hardship”. Governments play a leading role in the health systems, and public spending is, and must stay predominant in healthcare financing. However, there is a concern about the sustainability of and access to care, especially on the African continent.

To attain UHC on the African continent one needs to keep in mind the following scenarios:

– Global healthcare spending represents 10% of the global GDP; this is approximately USD 8.5 trillion. However, this proportion of expenditure varies from country to country.

– High income countries, who have 20% of the global population, account for 80% global health expenditure, of which 70% is public spending.

– Middle income countries have on average 50% public health spending and in low to lower-middle income countries, public health expenditure accounts for only 20% of global health expenditure, yet these countries need to cover the majority of the global population.

– As most African countries can be classified as low tolower-middle income countries, where most of the population is vulnerable and unable to pay for quality health services on their own, it is key that public spending on health must increase significantly.

The leading questions a government has when it comes to attaining UHC are:
– Who to protect
– How to finance it sustainably (e.g. how to increase the public health kitty)
– How to structure it

To successfully implement UHC in Africa, technical expertise and a holistic approach are necessary. In this regard, the private sector can join forces with the public sector in Public Private Partnership (PPP) in healthcare financing. This can give rise to a PPP insurance-based model that addresses the above key UHC attainment questions.

The role of insurers in a UHC PPP insurance-based model is to actively participate throughout the entire value chain;

1. Design a sustainable strategy for equitable and affordable access to care.
2. Leverage their expertise in implementing large projects supported by their wide range of skills and resources.
3. Provide budget visibility to the government by risk transfer and associate volatility at fixed costs.
4. Guarantee cost containment, limiting leakage through data analysis and fraud monitoring.
5. Attract investors to fill infrastructure gaps.

While governments have a leading and crucial responsibility in developing health policy, budget financing, developing, and regulating the health system, the private sector can play a vital role to bring efficiencies, effectiveness in systems, quality, and access to care.

One of the largest global insurers, AXA France, has the purpose to act for human progress by protecting what matters. Under this mandate, over the past years, the company has supported some of the Indian states and local state-owned insurers on state initiatives for secondary and tertiary healthcare protection designed for the most vulnerable. This partnership model has supported the Indian government to obtain more predictable healthcare budgets, increased efficiency in terms of cost-containment and an increase in standard of care by promoting competition between providers.

As African governments are (re-)thinking about their national healthcare coverage models, it is highly recommended to look outside the public sector and reach out to experienced private sector players that can support the attainment of UHC at national level. There is no one-size-fits-all strategy, but sharing best practices and lessons learned from other countries on the globe that face similar challenges when it comes to affordability, accessibility and quality of care is key. Collaboration with an experienced private sector player, who can adequately strategize, implement, and provide financial protection towards the attainment of UHC at country level will benefit a country in the long run as funds will be managed adequately, become predictive and risks can be de-risked via reinsurance models and ultimately the population will obtain more and better healthcare services.

About AXA

AXA France has protection at the core of their business, helping individuals, businesses, and societies to thrive. And AXA has been a leader, an innovator, an entrepreneurial company, fostering progress in all its dimensions. From the outset, AXA has been committed to acting as a force for collective good. From solidarity-based actions with AXA Hearts In Action to work on prevention issues with the AXA Research Fund and the fight against climate change, AXA has always been attentive to its social environment and embraced its responsibility as an insurer. This is theresponsibility for taking action upstream in order to better understand risks, with one goal in mind: to ensure better protection.

www.axa.com

About Africa Health Business

Africa Health Business (AHB) is a pan African boutique consulting firm, headquartered in Nairobi, Kenya, that aims to improve access to equitable healthcare in Africa. Our expert team provides clients with effective, evidence-based solutions for today’s complex healthcare challenges. Clients in government, the development space and the private sector rely on our research and advisory to inform and transform interactions with and use of healthcare systems.

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