After the Withdrawal of Similar Bill Prepared in 2020
By: Kebba AF Touray
Following the withdrawal of the National Health Insurance Bill 2020, Gambia’s Health Minister Dr. Ahmad Lamin Samateh, on Monday 8th November 2021, tabled the National Health Insurance Bill 2021 before lawmakers, in accordance with Standing Orders Clause 77 (3).
The tabling of the bill aims to secure legislative consideration, scrutiny and adoption of the said National Health Insurance Bill 2021.
Tabling the bill before the parliament, Minister Samateh, in line with Standing Orders 66 and 77 of the National Assembly told lawmakers during the second reading, that the bill seeks to protect, promote and fulfill the right to health care services.
“The right to affordable quality health care services is a fundamental human right recognized under the international covenant on economic, social and cultural rights, as well as other regional and international instruments which Gambia is a party to,” the Minister said; that to fulfill these rights, sustainable innovative health care financing, should be ensured and hence the national health insurance scheme; that Health financing is a core function of health systems which can enable progress towards universal health coverage through improved effective service coverage and financial protection.
“Madam Speaker, on the basis of the principle of universal health coverage, the Gambia government initiated the introduction of the national health insurance scheme, with the aim of improving access to affordable quality health care services for all”, he said.
The scheme he said is expected to benefit the population by eliminating or reducing out of pocket expenditure on health, which stands at 24.55 percent in 2017, and provide protection against the financial risk by increasing access to quality health care services and better service delivery.
He reminded the Assembly that one of the main building blocks of the health system is health financing; that this refers to raising or collection of revenue to pay for the operation of a health system.
“It is a key determinant of health system performance in terms of equity, efficiency and quality and it has three functions namely collection of revenue from various sources; pulling of funds and spreading of risk across larger population groups and the allocation or use of funds to purchase services from public and private providers of health care” Dr. Samateh said; that health financing in most countries, went through various stages of evolution from being free, to systems were tokens were asked for, for the provision of the health care services; that some countries went further into cash and carry systems, and as they continue to evolve, they have now established health insurance schemes.
He said the Gambia has never reached a cash and carry system, which he said would have meant catastrophic financial expenditure on the side of families; that as such, this step of cash and carry is being skipped in the country’s development to paying a token for services, jumping this cash and carry system.
According to the Minister, statistic available in the Gambia indicates that 48 percent of total health funding comes from international health development partners, raising challenges of sustainability and predictability of funding to the sector. He said Section 21 (6) subsection 4 of the Constitution, provides that the State shall endeavor to facilitate equal access to clean drinking and safe water, adequate health and medical services, habitable shelter, sufficient food and security to all persons.
“To fulfill this, the 2016-2017 national health account survey recommends that the Gambia needs to address the high level of out of pocket expenditure, in order to protect households against financial risks, by devising pre-payment mechanisms such as the national health or social health insurance scheme”, he said; that the bill also seeks to establish a national health insurance authority with the core mandate to implement, operate and manage the national health insurance scheme, register members of the national health insurance scheme, issue membership cards, and serve as a regulatory authority by registering and supervising private health insurance schemes that established in the bill.
The bill he said, will also establish a fund which will pay for the cost of health care services to members of the scheme, thereby providing access to health care service delivery and improve the quality of life in the country.
“I rise with pleasure to present the Bill entitled ‘National Health Insurance Bill 2021’ for consideration and adoption”, Minister Samateh told deputies as he moved the bill.