Interview: Léon Nzouba

How much of the low-income population is covered by the current health system?

LEON NZOUBA: The health and social protection systems Gabon has implemented are considered to be rather innovative within the sub-region. Low-income earners were the first targeted population in the enrolment process. Today, 80% of their medical expenses are covered by the National Health Insurance Fund and Social Guarantee (Caisse Nationale d’Assurance Maladie et de Garantie Sociale, CNAMGS). Yet, some citizens are still reluctant to enrol themselves in the system, perhaps in part because they do not believe that such an advanced system could work in a tropical country.

How can sector transparency be improved?

NZOUBA: Generally, the lack of transparency and the uncertainty of statistics hamper the development of any metric systems. The government is conscious of this situation in Gabon, and measures have already been taken. For example, in order to improve Gabonese medical record-keeping, it is worth noting that a number of hospital information systems have been implemented in numerous facilities, from University Hospital Centres (CHUs) to Regional Hospital Centres (CHRs). But to increase coordination between the different infrastructures, an integrated system – usable by all health professionals – must be implemented.

What is being done to gain more health care professionals within the sector?

NZOUBA: The recent construction of health facilities, like the UHC in Angondjé, may have improved infrastructure but has also revealed the lack of qualified staff. This is especially true for highly qualified professionals, like surgeons. We have also seen that health care professionals are concentrated in Libreville.

In the short-term, the government hopes to recruit foreign staff and training programmes will be put in place. In the medium-term, cooperation with local training facilities must be enhanced to adapt and harmonise the curricula of health workers. Finally, there is a long-term national plan to develop human resources.

How does the ministry aim to reduce the prevalence of communicable diseases?

NZOUBA: We aim to implement awareness campaigns in the fight against HIV/AIDS, malaria and tuberculosis. Today, treatments are given to the population already affected, but it is strongly believed that preventative work must be done to reduce infection. These plagues create new victims every day, and we have an obligation to minimise the occurrence of new cases.

What can be done to treat and prevent non-communicable diseases?

NZOUBA: The focus is on two areas: support for proven cases and preventive measures for populations at risk. We try to ensure that there is a facility that offers respectable health care for these initiatives.

For some diseases, such as cancer, most cases diagnosed in Gabon used to have to be evacuated abroad, to countries like France, South Africa and Morocco. As a result, the financial impact of these sorts of treatments to the country was very high, both with realised and opportunity costs. Therefore, we decided to build a national cancer institute. This is a project whose impact will certainly exceed national borders.

What role do public-private partnerships (PPPs) play in the health sector?

NZOUBA: According to the World Health Organisation, PPPs are among the top three priorities to enhance emerging health care sectors. Indeed, it is a great opportunity to benefit from an international expertise and to learn from those experts, while increasing access. Most of the CHRs, for example, are run in partnership with international private companies, such as Vamed. Yet, there could be greater involvement from private sector operators on a national level, especially in the management of certain health care departments.