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Loan injection to boost Gabon’s health care services
A new foreign funding facility for Gabon's health sector and an ambitious reform of the insurance system should enable the government to make much-needed improvements in health care despite declining oil revenues.
The French Development Agency (Agence Française de Développement, AFD) announced in March that it would renew its commitment to the Gabonese health sector with a €50m loan for the 2015-19 period. This follows on the back of a €10.5m project carried out between 2007 and 2014 that enabled the construction or refurbishment of seven maternity centres in the provinces of Estuaire and Woleu-Ntem.
The new loan will contribute to refurbishing some 30 health centres in four provinces  – Woleu-Ntem, Haut-Ogooué, Ogooué Ivindo and Ngouiné – along with the provision of medical equipment and training for 3000 staff.
Gabon lags behind some of its neighbours in terms of spending on health as a proportion of GDP, but the government has earmarked the sector as a priority following the launch of its 2011-15 National Health Strategy (Plan National de Développement Sanitaire, PNDS) in 2010. According to World Bank data, health care spending as a percentage of GDP stood at 3.8% in 2013. This compares to 5.1% of GDP in neighbouring Cameroon.
Universal health coverage
Despite anticipated lower oil revenues, the government is expected to continue to invest in health in 2015 through the PNDS. The plan aims to improve the overall governance of health care, reduce infant and maternal mortality, and invest in infrastructure.
Some of Gabon's achievements are noticeable, particularly with regard to its health insurance coverage, with the National Insurance and Social Welfare Fund (Caisse Nationale d’Assurance Maladie et de Garantie Sociale, CNAMGS) launched in 2007. Initially focused on providing insurance for the most vulnerable citizens, the programme was extended in 2010 to cover government workers, and again in 2013 to cover private sector employees, who were previously registered under the National Social Security Fund.
The insurance strategy will enable the government to better control costs induced by the reform, which will partly be financed through a mandatory health insurance levy. All three groups receive the same package of benefits, including medical consultation, nursing and diagnostic services, comprehensive basic maternal health care and hospital care. While public and private sector employees contribute to their own scheme, the coverage for the most vulnerable members of society is funded by a 10% levy on mobile phone companies and a 1.5% charge on international money transfers.
In January, the government announced the second phase of the enrolment of low-income Gabonese to the health scheme − with targets to raise enrolments above the current level of 36% of the population − through various campaigns led by CNAMGS.
Foreign assistance
Notwithstanding current efforts, an IMF report published in February said Gabon continued to rank lower than its peers in basic welfare provisions such as health and primary education. Moreover, the absence of up-to-date surveys limits the authorities’ capacity to account for recent trends in basic social indicators, the Fund added. In addition to these factors, the government will also need to keep a close eye on investments in health care this year, as falling oil revenues mean spending could come under strain, despite forecasts of GDP growth reaching 4.8% in 2015.
As a result, the health sector in Gabon continues to benefit from the support of a large number of development partners, including the World Bank, the World Health Organisation, and the African Development Bank (AfDB). Most of these organisations tend to focus on technical rather than financial assistance due to Gabon’s status as an upper-middle income country, which prevents it from receiving much financial aid. The AfDB has been the largest foreign contributor until now, but there has been some private sector involvement, with Austria’s VAMED managing 12 health centres, including three University Hospital Centres (Centres Hospitaliers Universitaires, CHU) in Angondjé, Owendo and Libreville.
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