Over 90 percent of Rwandans are covered by health insurance, President Paul Kagame told the World Health Assembly (WHA) which opened yesterday.

“Two-thirds of the costs are covered by contributions from beneficiaries, with government subsidising the remaining one-third,” Kagame told the world’s health leaders while delivering the assembly’s keynote address.

Universal health coverage (UHC) – ensuring that everyone has access to healthcare – is a key theme of the WHA, and the World Health Organisation (WHO) has committed to ensuring that an additional one billion people get health coverage by 2023.

“Ghana, Kenya, Morocco, and Senegal all offer a subsidy to insurance,” said Kagame. “Ethiopia is a pioneer in the use of Community Health Workers as the frontline of primary healthcare, and Ghana is also deploying them with great success.”

Massive shortage of medical personnel

But Kagame warned that Africa lacks the personnel and facilities to extend universal coverage to all, and that half the funding for this would have to go towards training and paying health workers.

The best thing we can do to prevent future [Ebola] outbreaks is to strengthen health systems everywhere.” – Tedros

“The International Labour Organisation estimates that Africa’s health economy workforce today is missing almost 17 million workers in both health and non-health occupations. Under Universal Health Coverage, that shortage is projected to increase to 26 million by 2030,” said Kagame.

WHO Director-General Dr Tedros Adhanom Ghebreyesus told the assembly that “all roads should lead to universal health coverage”.

Referring to the latest outbreak of Ebola in the Democratic Republic of Congo (DRC), Tedros said “health security and universal health coverage are two sides of the same coin. The best thing we can do to prevent future outbreaks is to strengthen health systems everywhere.”

Countries around the world are making progress in extending health coverage to their citizens: “India has announced its new National Health Protection Scheme, called Ayushman Bharat, which will benefit 500 million people and establish 150 000 health and wellness centres,” said Tedros.

‘Not a pipe dream’

“And Brazil has already submitted a list of 10 commitments it’s making on UHC.

Japan, a country that first introduced UHC in 1961, has taken a leadership role, hosting the UHC Forum in Tokyo last December, and committing $2.9 billion to support UHC around the world.

“Many of the other countries I have visited, including China, Cuba, Denmark, Oman, Saudi Arabia, Sri Lanka, Thailand, the United Arab Emirates and the United Kingdom are living proof that universal health coverage is not a pipedream; it’s a reality for countries all over the world, at all income levels.”

Tedros described Rwanda as “an outstanding example of how all countries at all income levels can make progress towards UHC”.

“At the health centre I visited in Mayange, just outside Kigali, all pregnant women deliver at the health centre, all children are vaccinated, and all residents have community health insurance. A focus on primary health care and community ownership – that is the best mix that can bring results.”

Meanwhile, last week South Africa’s Health Minister warned those opposing the National Health Insurance (NHI) that UHC was “one of the sustainable goals of the world”.

“I was supposed to present the NHI Bill to Cabinet but the president was away. He has taken a special interest in the NHI, so asked that I wait until he returns,” Motsoaledi said in his Budget Vote.

However, he said that the NHI was well on its way: “The rich must subsidise the poor. We are not going to apologise for that. The young must subsidise the old, the healthy must subsidise the sick.”