UHC Forward: Towards Universal Health Coverage

In co-operation with the Moroccan Government and the Financial Access to Health Services Community of Practice (FAHS CoP), the Expanding Coverage Track of the Joint Learning Network for Universal Health Coverage (JLN) recently organized a workshop in Marrakech, Morocco on the subject of “Equity in universal health care coverage: how to reach the poorest”. Immediately following the four day workshop which took place from September 24-27, 2012, the JLN hosted a one day session member on September 28, 2012 for JLN member countries from Sub-Saharan Africa to review action plans developed over the course of the workshop and to collectively brainstorm potential areas for peer and JLN support.

This was the first time that a JLN sponsored event supported the participation of parliamentarians focusing on the health sector. The presence of parliamentarians and senior level policymakers alongside technical experts was a unique opportunity that proved to be very powerful. Technical experts had listening ears as the policy makers described the political will required and the challenges they face in ensuring health care reaches the poorest, and policymakers were able to deepen their understanding and knowledge of the key operational and policy challenges that their countries are facing.

As a result of this type of interaction, the delegation from Ghana proposed introducing a provision into the National Health Insurance Scheme (NHIS) Bill pending before Ghana’s Parliament to require annual reporting on health equity under the NHIS. Such a provision was included in the NHIS Bill and was passed into law by Ghana’s Parliament on 1st October 2012.

The workshop convened over 90 representatives – including country delegations and individuals from Benin, Burkina Faso, Cote d’Ivoire, Ethiopia, Ghana, Kenya, Mali, Morocco, Nigeria, and Senegal -- to engage in a week of peer-to-peer exchange and learning on the topic of improving access to health care for the poorest. Participants included program administrators, technical experts, front line practitioners, and policy makers who are grappling with similar challenges as they implement reforms to expand health care coverage for the poorest. The Honorable Minister of Health of Morocco formally opened the workshop and the Honorable Minister of Health from Mali along with parliamentarians from Mali, Ghana, Nigeria, Morocco, Benin and Senegal were also in attendance.

One highlight of the workshop was the full day of site visits organized by the Moroccan Ministry of Health, to primary health care facilities, tertiary hospitals, and district scheme offices where the RAMED (Regime d'Assistance Medicale), Morocco’s medical assistance program for the poor, is being implemented. Workshop participants engaged directly with practitioners and program administrators, asking many questions to more fully understand the program’s target population, eligibility criteria for beneficiary enrollment, identification processes, services covered, financing mechanisms, key program achievements and scale-up challenges. Several participants remarked on Morocco’s vision and commitment to achieving universal health coverage while recognizing areas in which the RAMED could be further strengthened. Participants offered constructive feedback and suggestions, based on observations and their own country experiences, through forums and panel presentations in the days that followed the visits.

The workshop was particularly successful in bringing together country delegations to work together to discuss key challenges in reaching the poorest and to define country action plans with next steps for improving access to health care for their poorest populations. Country delegations presented their action plans on the final day of the workshop and worked together to identify linkages between countries and opportunities for continued joint-learning. The action plans highlighted several key takeaway messages that emerged from the workshop including:

• Defining and identifying the target population is not easy. Countries should work together and learn from each other to identify what works, what doesn’t, and how to improve these methods.
• Social protection programs really understand who the poor are – what lessons do these programs offer? How can they be leveraged?
• There is overwhelming consensus that strong political will and commitment are needed to carry programs for the poorest forward.
• Financial sustainability of programs/ schemes is a top of mind priority for countries. What innovative financing solutions can countries consider?
• Information, communication and awareness at both the beneficiary and health provider/facility level are key to the success of programs to reach the poorest.
• Strong monitoring and evaluation systems can help ensure that the poor are being reached.
• There is no one solution to reaching the poorest - country contexts are important.

The Marrakesh workshop marked the first collaboration between the FAHS CoP and JLN country delegations. It was highly successful in bringing together policymakers and technical experts to share and exchange knowledge, learn from experiences of others, and build new relationships. It also provided the opportunity for countries to critically assess their programs to reach the poorest. In the days immediately following the workshop, we have heard from many countries how they have begun to carry forward lessons learned from the workshop.

Please see the FAHS CoP Google group and the HHA CoP Facebook page for additional information and materials about this event. A final report and additional publications from the workshop will be shared soon. In the meantime, you may visit the links below to view photos from the event.

Marrakech Workshop – all photos

Marrakech Workshop – select photos edited

Questions regarding this event can be directed to Abeba Taddese (ataddese@resultsfordevelopment.org) or Marilyn Heymann (mheymann@resultsfordevelopment.org).