The role of the Government

The main building blocks of this proposed healthcare system rest on the notion that even poor households can and do pay for healthcare, and that their community can generate income to cover the recurrent costs of basic health units, to complement or replace weak public institutions.

This means a major shift from centralized, government decision-making to a lower, bottom-up healthcare delivery, financing and management through communities.

Yet, this in no means indicates that the government should renounce on its mandated duty to preserve the population’s health. What this system re-structuring proposes is a more strategically calculated role of the government in the healthcare sector.

In this proposal the government has 7 key roles to play:

i. Funding:

The state should continue funding the healthcare system and increase its allocated budget for this very sensitive sector. However, the government funding is no longer the main pillar behind the functioning of the system: it plays a supportive role that primarily supports and protects against any defects of the community-run scheme. Government funding should take place from both directions of the healthcare system:

  • Top-down subsidy: Allocated to the re-insurance organization, allowing lowering of re-insurance premiums and better integrated support of the micro-insurance schemes.
  • Bottom-up subsidy: By directly subsidizing the point of services, specially inpatient facilities, expensive medications and centers managing catastrophic illnesses and disabilities.

ii. Quality control, quality improvement, regulation and accreditation, legislative support:

This highly important role can only be played by the government. It includes implementing nation wide quality improvement programs, creating and applying regulatory measures to ensure quality of care and access to medications, developing accreditation standards and awarding accreditation labels to healthcare facilities and providers and also legislating relevant laws that facilitate the work and the sustainability of the micro-insurance units.

iii. Community health maintenance:

Through prevention, health awareness, disease control, health crisis management…etc.

iv. Production, procurement and insuring availability of resources:

Insuring the provision and availability of all components and needed resources for adequate healthcare services delivery. This includes qualified and trained human resources, equipments, infrastructure, medications and properly procured consumables.

v. Inter-sectoral coordination:

Coordinating with all other ministries and government bodies in areas of potential repercussions on population’s health.

vi. Crisis relief and disaster management protocols, infrastructure and resources

vii. Decentralizing decision-making:

This needs to be done within all elements of health provision to the local level, encouraging and facilitating direct purchaser / provider communication under a regulated environment.


E. Morelli, G.A. Onnis, W.L. Ammann, C. Sutter (Eds), Micro insurance – An Innovative tool for risk and disaster management, Global Risk Form GRF Davos, Davos, 2010

The Ottawa Charter: Health promotion, 1st International conference on Health promotion, Ottawa, World Health Organization,1986

D. Dror, C. Jacquier, Micro-insurance: Extending health insurance to the excluded, International Social Security Review, 2001, P. 15

The Bamako Initiative, Women’s and children’s health through funding and management of essential drugs at community level, World Health Organization, 1986

J.F. Outreville, The health insurance sector: Market segmentation & international trade in health services, 1998, P. 111-124