Dutch aid money has been made over to a private health insurance company rather than the government. In return, the company offers basic healthcare at a subsidised rate. Dutch development Minister Bert Koenders (photo) has praised the scheme more than once, describing it as an example of how aid can break new ground. But despite the positive signs, established aid agencies aren't entirely happy about it.
Since it began two years ago, around 45,000 poor Nigerians have taken up the insurance (which includes treatment for HIV-AIDS), and the scheme will soon expand to cover 70,000 farmers in Tanzania. The scheme originated with the Pharmaccess foundation which has been tackling AIDS in Africa since 2000. The group felt traditional methods of aid distribution weren't working properly - corrupt governments were siphoning off too much money for instance. So, says Professor Joep Lange of Pharmaccess they decided to try a different approach.
"Pharmaccess is actually pioneering providing subsidies to relatively poor people to buy health insurance and get decent healthcare. The healthcare that's being provided in sub-central Africa by the public sector is often dismal. Poor people spend a lot of money to buy healthcare, often in the private sector, and we thought it would be much better if they would actually put some money aside and protect themselves against financial shocks by taking up health insurance."
Complementary
The scheme is not intended to replace or undermine public healthcare - but Pharmaccess believe it has an important complementary role.
"We're absolutely not anti public, we actually have a good collaboration with the public sector, but the public sector is already over-burdened. There's enormous potential in the private sector to deliver healthcare, which is really under-utilized. And also for the sake of transparency we really want to see where every euro goes and that the larger part ends up in care for the patient."
Traditionally development agencies such as Oxfam have always worked with the public sector to improve healthcare - and not everyone is happy with the Pharmaccess scheme. NOVIB, the Dutch branch of Oxfam, is concerned that the insurance being offered is too expensive - despite being subsidised, and that the scheme is not inclusive. NOVIB's Harrie Ostingh explains:
"I understood from information from Pharmaccess that the insurance they are offering is the equivalent of about 25% of the annual income of a poor person. How do you make this a viable, sustainable option for poor people? At Oxfam NOVIB we are focusing our work especially on the poorest. Are these insurance schemes where people have to pay able to reach the poorest people? People who can enter these kinds of schemes are normally the people that are around the poverty line but really the chronic poor are not able to enter. . What Pharmaccess has been saying is that they are going to create insurance for Africa, and we think that's a bit unrealistic."
Oxfam Novib Fair © Flickr
"Going nowhere"
Professor Lange disagrees - and says it's Oxfam that's being unrealistic about what is and isn't possible in Africa.
"That's of course nonsense, you have to start somewhere. It was the same when HIV treatment came about. It was actually held up in a number of countries because people complained you couldn't treat everybody - so the alternative is to treat nobody!
You have to start somewhere, and gradually you build a system, which becomes more and more inclusive. If you start top-down with the idea that in relatively weak states you can include the whole population at once, that's dreaming - that's going nowhere."
Pharmaccess is confident that the idea will gradually gain greater hold in Africa, despite the objections. And that because the Foundation and their private sector partners are also working on medical infra-structure, the scheme will eventually benefit even those who don't take out insurance.
Louise Dunne & Davion Ford
Radio Netherlands
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A groundbreaking Dutch aid initiative is booking success in Nigeria. But established aid agencies are not happy with the scheme.
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