BACKGROUND INFORMATION
The year 2010 marked a key year in the worldwide movement for expanding Universal Health Coverage (UHC). The United Nation (UN) Summit on Millennium Development Goals (MDGs) in September and the November World Health Report—“Health Systems Financing: the Path to Universal Coverage”—drew increased attention to this critical discussion. Dr. Judith Rodin, Rockefeller Foundation President,in her opening keynote addressat the First Global Symposium on Health Systems Research in Montreux, Switzerland, on November 16, 2010 noted that as the world
“... enter the final stretch on the Millennium Development Goals, we can seize the momentum to steer reforms toward better health outcomes and financial protection, especially for poor and vulnerable groups in countries around the world. ... To measurably improve the health status and financial resilience of the poor, we need to build a global movement in support of universal health coverage – which WHO defines as ―access to appropriate health services for all, at an affordable cost”.
The statement is not only timely and inspiring. It also focuses attention on the essential element of developing a global movement in support of universal health coverage. This is something that has been missing in the global discourse. The rest of the world has stepped up the effort with some positive results. There has been tremendous global enthusiasm for the UHC movement since the World Health Assembly passed the universal health coverage resolution in 2005 and this is renewed under the new resolution in 2010.
It is very rarely however that one hears good news for positive and affirmative action from developing countries in developing effective health systems to address their challenges or generating any movement towards it. It is even more difficult to find forums that catalogue these issues and appreciate its significance to supporting the attainment of global goals. When therefore Ghana was recently recognised by the United Nations Development Programme and the World Health Organisation and awarded at its 2010 Global South-South Development Exposition for successful innovation for scaling up coverage under its health insurance scheme and fitting into broad development agenda, the world was put on notice: Finally an African and developing country success story to share with a possible global application.
While the rest of the world has an appreciation of this achievement, the question is still being asked by many African and developing countries as to the exact nature of social health insurance in general and what is unique about the Ghana health insurance that made it successful. How may the lessons apply in their different contexts? For some countries, there is a black out on information. Almost every dissemination mechanism used to date is in English leaving several African and developing countries in the dark. Thirdly, attempts by some international and civil society organisations to tell the story has led to distortions, inter-institutional hegemony over who had the greatest influence and undermining the opportunity for others to learn from the Ghana experience.
The interest in Ghana has led to different publications springing up with contradicting information. Acceptability of the positions in the documents is problematic. One such example is a recent Oxfam funded and edited publication that has been rejected by many as full of inaccuracies and an expression of disaffection with the World Bank. There are also general concerns in some World Bank publications that seek to point to an impending insolvency of the Ghana health insurance unless new resources are found. Their premise for this relies on the assumption that the Ghana insurance is premium based or at least should draw its sustenance from premiums. Two other reports considered centrist provide compelling evidence of the success of the scheme and widely considered as reflecting a balanced view of the situation. One of these is the CHeSS report with funding support from the Rockefeller Foundation that discussed the Ghana design, achievement and challenges in detail based on nationally validated data. It is sometimes difficult to correct conflicting impressions without throwing out what otherwise could be very useful suggestions from different angles. It is therefore important to interrogate carefully what the different reports are saying, and bring up what should be avoided where negative and replicated where positive across the developing world.
Without Africa telling its own story and opening up for dialogue from across the world, there is a real risk that the information will be distorted and opportunities for growth lost.