Health care coverage in Gabon has been transformed over the last decade by a comprehensive state-backed public scheme, the National Health Insurance and Social Security Fund (Caisse Nationale d’Assurance Maladie et de Garantie Sociale, CNAMGS). The initiative, on which the World Health Organisation (WHO) provided advice, was created in 2007 and began registering low-income Gabonese, including students, in 2009. It now covers 99% of the population living in poverty.
The scheme has since been expanded to cover government employees in 2011 and formally employed private sector and parastatal workers in 2013; there are now around 600,000 low-income Gabonese, 190,000 civil servants and 107,000 private sector and parastatal workers registered under its auspices. Self-employed Gabonese and those working in the informal sector, who account for over two-thirds of the workforce, are not yet covered, but the authorities are working on plans to extend the scheme to them as well.
While seeking to expand its reach, the authorities have also been working to tackle fraud in the system; 90,000 children on its books were struck off in February 2015 after it was discovered that they had been enrolled using falsified birth certificates, generating savings for the state of approximately CFA700m (€1.1m) per month.
Coverage & Financing
Under the CNAMGS, low-income beneficiaries and pregnant women are reimbursed for their entire medical costs, while other members of the scheme are refunded 80-90% of the cost of basic medical treatment and generic medicines, depending on the condition.
Such coverage is provided for free to citizens with monthly incomes below CFA80,000 (€120) via the Low Income Household Social Security Fund. This is funded in part through a 10% levy on the revenues of local mobile phone network operators, which was introduced in 2008, and a 1.5% tax on money transfers to countries outside the CEMAC zone. Coverage for public and private sector workers is funded via social security contributions by employees and their employers.
Impact
The programme has had a major financial impact on Gabonese households. For example, out-of-pocket spending fell from more than half (51%) of total health expenditure in the country in 2008 to less than a third (28%) in 2014, while the number of households facing catastrophic health care costs, defined as more than 40% of household income, has declined from 35% to 21%, according to the WHO. Health measures have also been improving: the number of children suffering from malnutrition in the country has halved.
Complementary Coverage
The government and private insurers entered into an agreement in 2014 with the aim of establishing a system under which the CNAMGS provides basic health insurance coverage while leaving private firms to offer complementary products. Despite this, Wilfrid Midongo, director of non-life and health coverage at Gabonese insurer Ogar, told OBG, companies remain able to offer primary health insurance as an alternative to the new system and continue to do so, though he added that the government was likely to prevent them from doing this in the near future. Nonetheless, he told OBG that the market for complementary health insurance remained promising, if somewhat challenging. “Historically margins in the health segment in the Inter-African Conference of Insurance Markets region have been poor, as clients consume health care resources heavily and the market has been prone to fraud,” Midongo said. “However, there is a lot of potential for development, particularly in the retail segment, which is not widely served, as people are looking for wide-ranging coverage.”
