The East African Community (EAC) has commissioned a study on how to harmonise social health protection in the five-member bloc.

Experts say that harmonised health insurance will ensure a healthier and more productive population currently estimated at 141.1 million.

The study entitled "Situational Analysis and Feasibility Study of Options for Harmonisation of Social Health Protection Systems towards Universal Access in the East African Partner States,” commenced February 21 and ends in July.

The aim is not to scrap national initiatives like Rwanda’s Mutuelles de santé, but to identify areas of improvement, harmonise legislation and policies to achieve universal health insurance.

A Rwanda-based consultancy firm, Global Health Issues and Solutions (GHIS), is leading the efforts in collaboration with national schools of public health. 

The schools include the University of Rwanda School of Public Health, Tanzania’s Ifakara Health Institute, Makerere University School of Public Health in Uganda, Burundi’s Institut National de Sante Publique and Nairobi University. 

Brandeis University in Boston, USA is also lending a hand.

GHIS managing director, Dr. Angélique Rwiyereka, is the project leader.

Consultants have already conducted preliminary study workshops in all EAC capitals and are now conducting interviews and focus group discussions to compile data for situational analysis.

Rwiyereka, a visiting scholar from Brandeis University, said preliminary findings suggest that some countries have "some initiatives” aimed at social health protection. Some, she said, have organised social insurance schemes while others provide vouchers or subsidised programs for vulnerable people.

Likely challenges

The challenges the project may face, Rwiyereka said, were three-fold: First is the need to consider local contexts when assessing options. Secondly, the EAC secretariat "will have to get the highest level of political commitment” from member states.

"Social protection needs a lot of attention from leaders, especially at the start; it is like a newborn that needs care from both parents. Since a lot of money needs to be invested, the challenge will be to keep momentum by looking at the medium and long term benefits of a healthy population for economic development.

"When finance Ministers are faced with tough budget choices it is easy to put medical protection out of the top priorities; however, once they understand that in order for them to get the money to allocate, there is a hard working population that managed to generate taxes because it was healthy, then social health protection will become a priority.”

The third possible hurdle is that between political commitment and implementation and between implementation and getting results, there were difficult and tough decisions and processes. She said that the study will suggest how to defy possible hurdles.

Rwanda’s community-based initiatives will provide insights.

"Mutuelles de santé is the base for the success of social health protection in Rwanda and other countries are learning from it. The way forward will be proposed by the current study and EAC leaders will decide on best options,” she said.

A harmonized EAC social health protection does not mean a unified mechanism, Rwiyereka said, adding: "Harmonization may mean similar policies that account for individual country systems.”

In Rwanda, the rate of enrollment in mutuelles de santé has oscillated above 75 percent in the past seven years, a significant increase from below 40 percent in 2005 when the number of women who died during pregnancy and childbirth was at 1075 per 100,000  births. 

By 2010 when mutuelles de santé climbed to 91 percent, and maternal mortality dropped to 487 per 100,000 live births.

"Once the study and harmonisation process are endorsed and implemented, it will be a welcome move for EAC citizens in terms of health insurance coverage and access to healthcare services as well as affordability of the healthcare services in the region, if well regulated,” said Spencer Bugingo, Legal Advisor in the Ministry of Health.

Recently, Dr. Mohammed Mohammed, head of quality assurance in Tanzania’s Ministry of Health, told a consultative meeting in Dar es Salaam that it was important for the region to attain 100 percent social health coverage.

Mohammed said a harmonised health insurance coverage will boost efforts to attain Millennium Development Goals aligned to the health sector.