A single, universal health care system that will eventually serve Gabon?s entire population is steadily expanding its coverage.
Gabon began rolling out its National Insurance and Social Welfare Fund (Caisse Nationale d?Assurance Maladie et de Garantie Sociale, CNAMGS) in 2008, as part of a broader bid to improve the standard of living. Initially focused on providing insurance for the most vulnerable citizens, the programme was extended in 2011 to cover government workers.
Private sector employees begin enrolment
A further development this year saw the scheme opened up to private sector workers, who were previously protected under the National Social Security Fund (Caisse Nationale de S?curit? Sociale).
Gabon?s private sector employees are expected to have completed the shift to the new scheme within the next three months, in line with a national bid to have all 1.5m citizens enrolled in the CNAMGS by the end of 2014.
The CNAMGS is partly financed through a levy system, known as redevance obligatoire ? l?assurance maladie (the obligatory health insurance levy). Coverage for the poorest sectors of society is funded by a 10% levy on mobile phone companies? turnover before tax, and a 1.5% charge on international money transfers. Funding for the CNAMGS has increased steadily since the scheme was introduced, rising from CFA12.5bn (?20m) in 2008 to CFA47bn in 2011 (?71m). In 2011, CFA17.5bn (?30m) of financing came directly from levies.
Gabon will be hoping that the drive to bring its citizens into the CNAMGS will see a broader impact on general health and wellness levels within the country.
Gabon is one of sub-Saharan Africa?s wealthiest nations in terms of per-capita income, but there is scope for improvement in basic indicators: life expectancy was 61 years for men and 64 for women in 2009, according to World Bank estimates.
The country benefits from highly-regarded clinical facilities, including the Albert Schweitzer Hospital in Lambar?n? ? which is this year celebrating its centenary and is ranked by the US National Institutes of Health as one of the top malarial research centres ? but as a proportion of GDP, health care spending is comparatively low, even taking account of the CNAMGS roll-out. The World Bank estimated Gabon?s health care spending for 2011 at 3% of GDP, trailing Equatorial Guinea (4%) and Cameroon (5%).
Evolving needs
In recent years, the health care sector has had to grapple with a rise in non-communicable illnesses, including cancer, hypertension and diabetes, linked to demographic shifts and lifestyle changes, while still addressing communicable diseases, such as malaria and HIV/AIDS. Greater access to care will be instrumental in easing the burden of both types of disease, allowing people to be treated sooner and more often.
With malaria still behind most medical appointments in Gabon, efforts are being stepped up to drive down infection rates. Information campaigns are urging greater use of mosquito nets, while new research into the development of an anti-malarial vaccine is under way. In August, Gabon signed a cooperation agreement with Cuba for assistance in fighting the disease.
Keeping costs under control
Despite Gabon?s comparatively low levels of spending on health, the World Health Organisation (WHO) has urged the country to keep the cost of rolling out its CNAMGS in check.
?Certainly costs need to be kept under control and there is still work to be done in terms of reducing the co-payments or modulating them according to the members? ability to pay,? Riku Eloivainio, a WHO health economist, said in a report published earlier this year. ?But the CNAMGS represents a major step forward because, at the end of the day, those now covered by it have better access to health services making them healthier and wealthier.?
Gabon will be aware that countries operating social health insurance schemes in difficult times are feeling the strain of mounting costs. However, while aspects of the CNAMGS?s operations will need to be monitored and adjusted over time, particularly its financing, the system marks a significant achievement for the country.
