"Japan is no longer in the post-war period."
This phrase in the 1956 economic white paper published by the Japanese government became popular among Japanese citizens. It was five years later, in 1961, that universal health insurance coverage was achieved. All Japanese citizens were covered by some kind of social health insurance.
"I remember that adults around me were delighted that they would be able to go to the doctor without worrying about money. Social stability leads to economic growth. I want to help the Senegalese realize it as the Japanese did," said JICA expert Dr. Toshiyasu Shimizu, who is working for the achievement of Universal Health Coverage (UHC) in Senegal, West Africa.
This article, Part 2 of the series "Health for All," gives an introduction to JICA’s activities applying the experiences and lessons of Japan's UHC to other countries.
This Regional Hospital in Senegal is well-equipped. Health expenditures have become an issue to be addressed in addition to health services. (Photo: JICA/Shinichi Kuno)
One of the features of Japan's universal health insurance coverage is that it was built on two pillars: employment-based health insurance and community-based health insurance. Community-based National Health Insurance began to be operated by local governments and to have compulsory enrollment in 1948. In 1955, it began to be subsidized by the national government. Also, civil registration and individual income flow management, which had been established before 1961, were the foundation for basing insurance premiums on affordability. The Japanese health insurance system has continuously been revised up to the present.
Dr. Cheiki Seidi Aboubeker Mbengue, the late director of the Universal Health Insurance Coverage Agency, right, and Dr. Toshiyasu Shimizu in Tokyo in 2015 for an international conference on universal health coverage.
In Senegal, the Universal Health Insurance Coverage Agency was established in 2015, and its mission is to cover 80 percent of citizens with the health insurance systems or free health care initiatives by 2021. However, frequent delays in disbursement of government subsidies and insurance refunds under these systems sometimes lead to refusal by health facilities to see patients. The coverage of the systems increased greatly, from 20 percent in 2013 to 49 percent in June 2017, but there are still many challenges in achieving the 80 percent objective.
Against this background, the Project for Strengthening Capacity of Community Health Insurance System and Free Health Care Initiatives, in which Dr. Shimizu serves as the chief advisor, will provide training for the Universal Health Insurance Coverage Agency, mutual health organizations and health facilities that are responsible for community health insurance.
Dr. Shimizu had been the technical advisor of the Senegal Ministry of Health and Social Action for three years since August 2014. He worked with the first Director General of the Universal Health Insurance Coveragy Agency, Dr. Cheiki Seidi Aboubeker Mbengue, to promote UHC in Senegal. Dr. Mbengue was hospitalized for heart disease in June 2017. He signed the Record of Discussions for the Project from his hospital bed, then passed away in July. He was 53. His colleagues and Dr. Shimizu started the Project this October with the last wish of the late Dr. Mbengue to achieve UHC in Senegal in mind.
Health volunteers get training in how to use picture-based educational materials when visiting the homes of pregnant women.
In 2013, the Philippines improved its insurance system to enroll pregnant women and to increase the insurance subsidy for people with low incomes.
The Project for Cordillera-wide Strengthening of the Local Health System for Effective and Efficient Delivery of Maternal and Child Health Services (2012-2017) aimed to enable pregnant women in a mountainous area to give birth safely. Under the project, health volunteers started to encourage pregnant women to enroll in the health insurance system, and if they could not pay the insurance premiums, volunteers contacted the welfare office or took other steps to help. The project was based in part on Japan's experiences. Keeping records of all pregnant women encouraged their enrollment in insurance.
As a result, the insurance enrollment rate for pregnant women, which was 50 percent in the second year of the project, increased to 79 percent by the fourth year. The facility-based delivery rate and maternal mortality ratio also improved.
Achieving UHC is a national strategy for Viet Nam. The government decided to increase the enrollment rate of social health insurance from 80 percent (as of late 2016) to 90 percent by 2020. On the other hand, with the society aging, the total health expenditure is expected to increase.
In 2016, the Ministry of Health decided to establish a National Advisory Council on Health Insurance Policy based on Japan's Central Social Insurance Medical Council to improve its health insurance system, such as the fee schedule and provider payment methods. In October of this year, the government and JICA started the Project of Development and Strengthening the Management of Provider Payment Methods and Basic Health Service Package Reimbursed by Health Insurance Fund in Viet Nam. JICA assigned experts to provide technical support to the council secretariat. The experts will utilize Japanese experiences to help with policymaking and improving the management of the health insurance system.