Introduction

 

Whereas the idea of Universal Health Coverage (UHC) is relatively new, the ideals it espouses are not. These ideals take on a comprehensive approach towards health and include disease prevention, effective treatment, rehabilitation and palliative care.  In realizing this, out-of-pocket expenditure ought to be minimized so that the vulnerable are not further impoverished, which may exacerbate their precarious circumstances. But how do these lofty aspirations translate into tangible benefits for Africa’s vulnerable adolescents, especially women and girls?

 

Diagnosing the Problem

 

Africa, for the better part of its known history, has been synonymous with disease. While there has been no shortage of grim images and commentary on its epidemics, there is a dearth of solid and disaggregated data on the extent of its disease burden and related healthcare challenges. It is therefore incumbent upon governments to gather empirical data on the prevalence of various epidemics such as Ebola and the new Covid-19, protracted challenges like malaria and HIV, the entire spectrum of sexual and reproductive health rights, and more importantly, the less prioritized areas of mental health and disability rights.  It is only by grasping the full extent of the challenge at hand that an appropriate response can be designed.

 

Borrowing from Women’s Groups

 

One of the under reported success stories in Africa is the role of informal women’s savings groups in mitigating poverty and vulnerability.  In these groups, women pool their individual savings and in turn are allowed to borrow up to four times the amount they have in savings. It is generally expected that they will invest this money in a profitable venture like farming or trade. However, there are instances where funds can be also availed to a member in the event that they are struck by a contingency such as household health emergencies. 

 

Armed with empirical data on the prevalent health challenges facing various communities, a community-based health insurance scheme can then be designed using the success of women’s savings groups as a blueprint. The beauty with such an approach is that it enables the states to avail resources to the various communities in line with their bigger burdens. For instance, in communities where child marriage is an entrenched culture, the states’ focus would be on equipping local health facilities to handle sexual and reproductive health challenges like obstetric fistula, pre and post-natal management, among others. 

 

Similarly, communities emerging from conflict should have their local health facilities empowered to address disability rights and mental health challenges. Epidemic prone communities like those residing along national borders should have health facilities capable of isolating, testing and treating suspected cases. The community-based health insurance scheme would then fill in systemic gaps that often impede access to those health facilities such as provision of reliable transportation for all, case follow up, subsidizing the cost of treatments that fall outside the government provisions and other interventions.

 

It goes without saying that this proposed approach is not a call to subsidize the government’s healthcare budget. Rather, it draws upon the collective power of local communities to plug the inevitable gaps in government interventions regarding the community’s most prevalent challenges such that every member in need can be adequately taken care of. 

 

Towards Sustainability 

 

Informal savings groups are largely the handiwork of women because it is women and girls who bear the brunt of poverty with all its attendant vulnerabilities. They were born out of necessity, and so it is in every member’s interest to ensure their survival. This may explain why these groups have stood the test of time and continue to multiply in terms of membership and resource pool. 

Similarly, African women not only share the disease burden with their male counterparts for common ailments such as malaria, but also have the peculiar challenge of sexual and reproductive health challenges. They also carry a disproportionate burden of HIV/AIDS due to their culturally conditioned weaker position in protecting themselves from infection. As such, a women-led community-based health insurance mechanism is a self-sustaining model based on the strength of its motivation, not the depth and breadth of its resource pool.

 

Conclusion

 

Repeated affliction tends to build resilience, just as repeated infection tends to build immunity. The success of women’s savings groups in fighting household poverty in Africa is largely attributable to the disproportionate burden of poverty and vulnerability that African women have had to shoulder over the years. Similarly, African women and girls continue to disproportionately bear the disease burden, while great governmental health interventions are often undone by simple inadequacies such as a shortage of fuel for ambulances or faulty power generators. A pregnancy complication under such circumstances, for instance, can not wait for procurement bureaucracy to run its course. It is high time we replicate the success of women savings groups and deploy the model at another battle front where African women and girls are the disproportionate victims.