Chronicle/ Effective universal health insurance in Togo: everyone joins in

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Extract from the article: Se soigner au Togo, pour quelqu’un qui n’a pas les moyens, relève de la croix et de la bannière. Autrement dit, avoir accès aux services sanitaires demeure un luxe pour de nombreux Togolais. Ici, le dicton « la santé n’a pas de prix mais elle a un co

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For those without the means, access to health care in Togo is a matter of cross and banner. In other words, access to health services remains a luxury for many Togolese. Here, the saying «health has no price, but it has a cost» takes on its full meaning. In Africa, in addition to poverty, the health system faces many challenges that make it difficult to afford healthcare. Even if a user is able to obtain a consultation, he or she often has to undergo examinations and pay for prescriptions. People with little financial income often have several dependents. For those with health insurance, the burden is lessened, but not everyone has access to it.

Assurance Universelle Maladie (AMU) is a social benefit organized by the State to cover the cost of health care for the population, by pooling risks and resources. According to the definition, this insurance benefits everyone, even those with no income.Indeed, this insurance will give the poorest people the opportunity to seek treatment at any time, as long as they contribute to the common basket.It's an opportunity for the whole population.Only 8% of Togolese have benefited from compulsory insurance from the Institut National d'Assurance Maladie (INAM) since its introduction in 2012. 

However, for the mutualized system to work, everyone will have their part to play. Of course, the support of the government is fundamental, but its proper management by beneficiaries and providers should not be overlooked.

Guaranteeing access to essential healthcare for all segments of the population, especially the poor and vulnerable.

AMU offers a wide range of healthcare services. These include care for illness, non-occupational accidents, maternity and physical and functional rehabilitation. Any person who is subject to universal health insurance and meets the required conditions is entitled to general and specialist medical consultations, hospitalization, essential health products, medical and paramedical procedures, medical imaging examinations, medical biology examinations, appliances and prostheses, transport of patients from one health facility to another, and care related to pregnancy and childbirth.

UHI, which has become one of the sustainable development priorities since 2015, measures countries' ability to ensure that every person receives the healthcare they need, when and where they need it, without being exposed to financial hardship.This covers all essential health services, from health promotion to prevention, protection, treatment, rehabilitation and palliative care.To set up a system of universal health coverage, countries need to have two components in mind. On the one hand, ensuring the availability of essential health services, and on the other, putting in place mechanisms to protect different segments of the population from financial hardship when accessing health services.

One-stop shop for private-sector workers, from April 2024

In Togo, the Caisse Nationale de Sécurité Sociale (CNSS) is set to start covering private-sector workers who have already taken out voluntary health insurance with the Institut National d'Assurance Maladie (INAM), effectively from April 1, 2024, under the AMU.

«Contributions for your health insurance will be paid together with other contributions to the CNSS, while benefits will continue to be paid by the INAM during a three-month waiting period, i.e. from January to March 2024», indicated the Caisse's General Manager, Ingrid Awade, in a press release dated January 05, 2024.

Thus, from April 1 this year, CNSS is expected to launch a one-stop shop, aimed at taking over all its social benefits for private-sector workers.  «I hereby inform you of your migration from the health insurance scheme managed by INAM to the CNSS's Universal Health Insurance (AMU) scheme», «with a view to providing you with a one-stop shop for all your social benefits, including health coverage», adds Ingrid Awade.

As part of the roll-out of AMU in Togo, the State has shared the burden between the two structures: INAM for public-sector employees and civil servants, and CNSS for private-sector employees.

Fighting poverty

As well as helping to improve access to health care and services, health insurance can play an important role in the fight against poverty. According to the findings of a study on household living conditions carried out in December 2006, over 60% of Togolese households express family health problems as a major concern, and in 2008, the national health accounts clearly highlighted the considerable role played by households in financing health expenditure, with over 50% of the country's total health spending. Of this expenditure, 78% goes on pharmaceuticals and other medical consumables, 12% on curative outpatient care and 10% on curative inpatient care.

The economic consequences of ill-health can have a major impoverishing effect, especially for those already destitute or living just above the poverty line, preventing the former from recovering from their condition, and dragging the latter back into poverty. The loss of income caused by ill-health that prevents people from working, or worse, the premature death of the family breadwinner, as well as the direct and indirect costs of care, drain already very limited resources to the detriment of other basic needs, creating a debt from which it becomes difficult to get out.

Health insurance for all will contribute to the well-being and good health of all segments of the Togolese population.It is often said that illness does not prevent. Another certainty is that no one can determine exactly when and from what pathology they will suffer, and in most cases when this happens, the costs of treatment can be very high. Universal health insurance will enable everyone to cope with these often difficult situations by providing protection against the financial consequences of illness.

So what's to be done?

We need to raise awareness so that everyone understands that AMU serves the general interest. So it belongs to everyone, and it's up to the beneficiaries to take care of it.It's a system that will have a positive impact on the health system, the health of the population and the economic development of communities.

William O.