Community-wide health insurance is a hope for a country whose health system is weak; will it be

by Ayele Addis Ambelu ; +251918718307

Hello, dear followers of our show. How are you doing? In today’s event, we will briefly discuss the hopes and challenges that Ethiopia has brought to the country’s healthcare system after the 10-year community-wide health insurance service began to be implemented. We have also heard that the government has made arrangements, with the help of the legal framework, to start an insurance service that will make social health insurance accessible to other parties, including government employees, in addition to community health insurance services. If you stay with us, you will hear the event where we talked to service providers and other stakeholders, including the opinions of the service users. I am Ayele Addis Ambelu, your health program producer.

Germany was the first to introduce public health services to the world in 1883, according to the Gregorian calendar. One hundred forty years of social health insurance in Germany has allowed the country to be one of the leading countries with one of the world’s top, strict, and well-served health systems. This health insurance service must cover anyone who has obtained a residence permit in Germany. This has enabled an individual in any living condition to live in the country’s most expensive health care system without any problems getting complete health care. Respected series of our show, we did not raise this for no reason. We will try to analyze the community health insurance service, established in Ethiopia for ten years, from its purpose to the level it has reached today. Mrs. Frehiwot Abebe is the director general of the Ethiopian Health and Welfare Service. You will recall that based on the experience taken from the social health insurance service at the international level, it was started to provide two types of health insurance services in Ethiopia.

The problem of social health insurance
Recognizing that expanding health service coverage is a significant part of the country’s smooth social and economic development, Ethiopia has issued a decree to make social health insurance services accessible to all in the last seven years.

Health insurance
According to the same decree 690/2002, the country has three types of health insurance service systems. One of the three is social health insurance coverage, which covers all government employees and pensioners. The others are private and community health insurance services. He was told that the social health insurance service, expected to be implemented in Ethiopia, has encountered a problem. The social health insurance system, which was supposed to be started by government offices and was based on obligation, should have been implemented two years ago.

“In our calendar, around 2004 and 2003, the two types of health insurance were started in our country, which is called the first social health insurance; What we call social health insurance benefiting wage earners and pensioners, and the other social health insurance helping most of the society or more than 80 percent of the people, was designed as a country.

In Ethiopia, community-wide health insurance services have been prioritized for implementation as more than 80 percent of the population lives in rural areas and farmers, herders, or other informal occupations. The service, which is being implemented in selected districts of Oromia, Amara, Tigray, and Southern regions, has reached up to 45 million Ethiopians through the service, Ms. Frehiwot says.

“In our country, we are implementing it in 894 districts. In these districts, membership is at the family level. With this, we have 45 million users.

Indeed it is. In poor countries like Ethiopia, even in economically developed countries, the payment for health services is reaching an unaffordable level. When the service is covered by such insurance, it will bring more or less relief.

Mr. Santayehu Hunene Ube, who resides in Mesobo kebele of Elmana Densa district of West Gojam zone, is one of the farmers who first got the community health insurance service from his kebele. They shared with us what they faced in the past to access health care and what they experienced after becoming a member, either themselves or others.

Another farmer who is a resident of Jimma Zone, who says he is a beneficiary of the community health insurance service, talks about the blessings the insurance service has brought him and the problems he has faced.

“I came and underwent surgery on the previous Arafah holiday. I have treated for free what I could not afford to spend much money on. I only bought Glucose, which was washed in Hede. I bought one from a foreign pharmacy for 300 birr when the liquid was lost here.

Farmers who did not want to be named shared the same idea while treated at Jimma Hospital.
“We were well received when we came here. They came and treated us where we were sleeping. We also got a needle. But our only problem is the purchase of medicine. The purchase of pharmacy medicine costs us up to two thousand three thousand birr. »

Social health insurance in Ethiopia
To implement the social health insurance system in all government offices, a decree was issued in 2002, and a structure was prepared for it. But the system has not been implemented yet due to some problems.

Minister of Health
To find out the reason, the House of People’s Representatives asked the recently appointed Minister of Health, Prof. Yifru Birhanen, on Thursday, December 27, 2022. It is known that he called the council and asked them to explain.

The minister explained that the system has not yet been implemented “because it has not been adequately prepared, the understanding of the workers is low, and there are problems in the supply of medicine and the environment of health facilities.”Another community-wide health insurance is intended to benefit farmers and herders in rural areas, and more than 18 million people have benefited from the pilot project, according to Ahmed Imano, Director of Public Relations and Communications at the Ministry of Health. The director mentioned that this insurance will be implemented nationwide this year.
Health expert Dr. Yigerum Abebe told Deutsche Welle that although the insurance companies in the country provide health insurance services to some people, their services are not very meaningful in a country with a population of 100 million. For this purpose, the government established two types of insurance: social health insurance and community-wide health insurance. Still, it was expected that “in the end, both will be merged into one national insurance,” says Dr. Yemu. Dr. Yele explained many other reasons that have prevented the social health insurance system from being implemented.

Dr. Yigemu, who said that the country is primarily dependent on foreign aid to carry out its program in the health sector, and this cannot continue in this form, explained that it is essential to introduce a social health insurance system.

There is no denying that health insurance will play an essential role for the people who are at the lowest level of living and who are the highest in number. From what the users say, it seems to be a step forward from the earlier self-service access.

However, government health facilities are usually in trouble providing insurance services to serve the wider community and have raised the capacity to do work based on the contract. Or they face a strong challenge.

According to Mr. Awol Mohammed, who is in charge of the government hospital in Jimma Zone, Dedo District, his hospital has faced a challenge in providing financial services to the members of the community insurance service.

The director general of the health insurance service, Ms. Freyevat Abebe, who says that she agrees with the complaints made by the users and stakeholders about the supply problem facing the service, talks about whether they are expanding community drug stores or pharmacies in cooperation with regional administrations.

Another issue that needs to be raised is the accessibility of community health insurance services to those who cannot afford them. Mr. Tsgaye Abebe says that everything should not be left to the government engaged in flower development and other import and export businesses; he says that he bought the same insurance policy for more than 800 people in two years.

Ato Tsgaye is also saying that the insurance that plays a role in alleviating such social problems has given the country hope.

We have heard that a decree has been approved to implement the social health insurance service that Ethiopia has started to implement. No social health or insurance service benefits those working regularly, including government employees.

However, the problem faced by the social insurance service, which started earlier and benefited most of society, should be solved from the root. It is essential to update the system developed to manage this and learn from the experience of countries with better experience. Suppose a government challenged by war, conflict, and instability for years can maintain an orderly and insured health service. In that case, it indicates a way to solve other social problems.