Rwanda Achieves Universal Healthcare

Rwanda continues to impress beyond measure.

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The Rwandan healthcare system now covers over 90% of the population, the highest coverage rate in Africa. The informal community-based health insurance (CBHI) scheme, known as Mutuelle de Santé, focuses mainly on maternal and child health. According to the East African, the scheme is one of the most successful on the continent and it is credited for the country’s lower maternal and infant mortality rates of over 70% since 2000.

CBHI was originally voluntary and when contributions became compulsory, many saw it as paving the way to national coverage. Rwanda’s potential model for Africa is pivotal to development, as the WHO estimates that 100 million people are pushed into poverty and 150 million suffer financial catastrophe because of out-of-pocket expenditure on health services every year. Kenya is now using the CBHI model in pilot programs, while Tanzania and Uganda are openly considering it.

Benjamin Chemouni argues that Rwanda’s expansion of health insurance coverage is made possible by the concentration of power in the ruling coalition. He says the CBHI policy and its implementation are forged through both political interests and ideology. Kenya, Tanzania, and Uganda are certainly different milieus than Rwanda, so time will tell how the CBHI programs would fare in other countries.

If any country could make this model a success, however, it’s Rwanda. I have written about Africa’s innovation leaps forward and Rwanda is at the fore. Pretty impressive from a country that has done so much rebuilding in just a few decades since massive conflict. We can’t help but root for Rwandans.

 

Remarks on social services in the Niger Delta

A newborn in the Niger Delta
A newborn in the Niger Delta

 

An NGO researcher just conducted an interview with me regarding the state of service delivery, i.e. social and government services, in the Niger Delta. Below are a few of the transcribed questions and answers.

 

1. How would you describe the current state of service delivery[1] for most communities in the Niger Delta? 

Service delivery is non-existent in most areas, and sporadic or haphazard in the remaining ones.  I think that part of the reason communities so often look to oil companies to offer social services and build basic infrastructure is that the state has been so wholly unable to do any of these things since independence.  It is as if communities have given up on their own government ever acting as a government should, which requires providing basic services to its population. As is common in countries with rampant corruption, projects often begin but then are abandoned because funds disappeared or there was a change in management of that project. In the Niger Delta there are half-finished bridges, classrooms without roofs, and empty hospitals that don’t even have electricity. Additionally, a lack of human capital and maintenance of services mean that as soon as any project is finished, it will only be a matter of time until it is useless because no one can perform maintenance.  It seems that almost as soon as a road is finished, poor construction materials mean that it needs to be fixed again but there is mechanism in which to have that road repaired. This lack of maintenance is an issue that only capacity-building can address.

2. Whose responsibility do you believe it is to improve service delivery in the region, e.g. government agencies like MNDA or the NDDC, or oil companies operating in the region?

It is responsibility of government agencies to improve social services.  The basis of democracy is that citizens pay taxes to their government, vote for their leaders, and then those leaders use those taxes in a responsible manner to provide necessary collective goods that improve everyone’s lives.  Because the Nigerian government can rely on oil profits rather than taxes, and corruption makes elections less meaningful, there is no accountability of state actors towards the citizenry. Part of this government duty is to monitor the behavior of private economic actors like oil companies. Although I believe staunchly in corporate responsibility, it is impossible for a corporation to fully monitor itself; by definition monitoring must come from an outside party, like a government agency.

3. What impact do you think the current state of service delivery has on peace and conflict in the Niger Delta region? 

Lack of service delivery has increased rates of poverty and negatively impacted quality of life, which gives people “nothing to lose” when it comes to engaging in violence.  It also creates a dynamic in which too many people are competing for scant social services and resources, leading to increased tensions. Poverty and lack of services drives rural dwellers into cities like Port Harcourt and Yenagoa, where they may come into conflict with residents already living there, be forced into crime out of necessity, and and don’t have kinship or community networks that would otherwise mitigate their propensity for violence.

 4. Do you think that improved service delivery would increase security in the region?

Yes. Mostly obviously, it would remove violence caused by need, in other words, conflicts over obtaining basic goods.  Additionally, it would remove the incentive for rural Nigerians to move to new areas in search of such services, thus minimizing the conflict that occurs among internally displaces populations and between new urban dwellers and older ones.


[1] “Service delivery” means the quality and availability of essential services, such as health care, primary education,  and basic infrastructure such as reliable access to water, electricity, and road networks.

Birth rates in Africa

African baby carrier

I came across this blog post about the number of countries in Africa (54) after reading about world birth rates on the CIA World Factbook site. In looking at a list of the countries in the world with the highest birth rates, I saw that with the exception of Afghanistan and East Timor, all top thirty were African countries. Niger has the highest birthrate in the world (and is considered the poorest by most measurements) and Nigeria is ranked #13. Seeing those 28 slots taken by African countries made me think that that must be over half of Africa, and it is.

Blogala Maho

The UN membership roster contains 54 African states, and that of the African Union contains 53. While the AU list includes suspended members, it does not include a count for Morocco, who has decided to stay out of the AU. Thus AU’s implied total can also be said to be 54. Of these, 48 states are found on the actual continent, while 6 are island nations.

However, Africa is about to get a brand new country. Within less than two weeks, South Sudan will hold a referendum on whether or not to secede from the rest of Sudan. If it does secede, which currently seems likely, it would mean that the new total will soon be 55, right? Well, no, because the current total of 54 is true only to some degree.

Before I go on: what’s a country, anyway? I’m going to be somewhat untechnical here and use ‘country’…

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Can Kenya make the “youth bulge” a source of strength, not a threat?

Africa Health Dialogue

Population momentum: Fertility rates fall, but global population explosion goes on

The reality of falling fertility rates while global ‘population explosion’ goes on is depicted in the Figure above. The relentless growth in population might seem paradoxical given that the world’s average birth-rate has been slowly falling for decades. Humanity’s numbers continue to climb because of what scientists call population momentum. As a result of unchecked fertility in decades past, coupled with reduced child mortality, many people are now in their prime reproductive years, making even modest rates of fertility yield huge population increases. This according to John Bongaarts of Population Council in New York translates to adding more than 70 million people to the planet every year, which has been happening since the 1970s. The African continent is expected to double in population by the middle of this century, adding 1 billion people despite the ravages of AIDS and…

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