The entrance of The Hague University
‘Development cooperation should become more effective and less fragmented.’ This is what Bert Koenders, Dutch Minister for Developmental Cooperation, said in his opening speech at Afrikadag in a packed lecture-hall at The Hague University on Saturday April 25th. According to Koenders, especially in these times of crisis with less money to spend the call for effective programs becomes even more pertinent. Present were representatives of NGOs, experts and policy makers in the field of developmental cooperation and people generally interested in Africa.
Koenders was not just critical. In his speech he praised the many innovative initiatives and all the hard work by so many to fight poverty and inequity in the world. He emphasised that developmental cooperation carried out by the many organizations present at the Afrikadag has led to positive results. Results he has personally witnessed in Congo and Mali.
By modernizing and innovating development cooperation, Koenders believes more can be achieved. Developmental aid should be used to initiate dynamic programs together with local organizations, African governments and the private sector. These partnerships can raise the effectiveness of the programs.
Workshop on new effective approach
Following the opening speech the visitors of Afrikadag attended a variety of workshops, debates and lectures, amongst which a workshop hosted by the Health Insurance Fund and PharmAccess. The theme of the workshop is closely connected to the call for more effectiveness: “a new paradigm for increased access to health care in Africa.” The new paradigm stands for a new effective approach: the Health Insurance Fund is building quality health care systems for low-income communities, by using the private sector and introducing subsidized health insurance.
This approach was presented by Onno Schellekens, Managing Director of PharmAccess, the implementing partner of the Health Insurance Fund. Aaltje de Roos, Senior Policy Advisor Sustainable Economic Development of the Dutch Ministry of Development Cooperation, elaborated on this innovative method from a public sector perspective.
Firstly, René Dubbeldam, Senior Public Health Consultant and moderator of the workshop, began by explaining why a new approach is essential. ‘Although financial inputs in African health care have tripled over the last fifteen years, there are serious doubts that this has led to the required results on the output side.’ The public sector has in his eyes been unable to deliver.
Onno Schellekens discusses the poor state of the public health sector in Africa
This hypothesis was also the starting point of the presentation by Schellekens: ‘Ideally the public sector should provide quality health care for all. But how can you expect a government, who barely manages to keep one traffic light working in the whole country, to deliver health care nationwide with a limited budget?’ A result of the public sector approach is that people pay a high percentage out-of-pocket for inadequate health care, making them fall into the poverty trap. This leads to tremendous impoverishment.
By introducing community insurance for low-income people together with local insurance companies, these people do get access to quality health care. ‘Because they risk-pool, meaning that they create a pot of money, they can cross-subsidize each other over time, like we do here in the Netherlands’, explains Schellekens. Further, it creates a steady demand for care and with that a steady income for these private clinics. This allows these clinics to invest in the quality and capacity of healthcare delivery.
Aaltje de Roos
Supporting both the demand and the supply side through the introduction of insurance is according to Aaltje de Roos the key innovative feature of the program. Affordable quality health means that a community is better equipped to work. Insurance raises their productivity and lowers their vulnerability. And establishing effective private delivery systems, works as a catalyst for more investment.
Aaltje de Roos present the program from a public sector perspective. René Dubbeldam sits on the right behind the desk.
The program is an example of an innovative public-private partnership. De Roos: ‘The insurance companies in the Netherlands and in Africa have experience with insurance, but lack the economic incentive to invest, while our Ministry has the money, but no knowledge of insurance.’ A part from delivering quality health care, this symbiosis should really work as a force to build an attractive health economy. This concept has drawn the attention of the local government of Kwara State and even of the central government in Nigeria. The Nigerian government now uses the program as a blueprint for the possible introduction of a national insurance scheme. For the above reasons Minister Koenders has on many occasions expressed his support for the programs of the Health Insurance Fund.