January 2024: integration of the various strata into the universal health insurance scheme

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Extract from the article: The Council of Ministers met on Wednesday 04 October 2023 under the chairmanship of His Excellency Faure Essozimna Gnassingbé, President of the Republic. The main topic of discussion was universal health insurance. In line with his policy of social c

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The Council of Ministers met on Wednesday 04 October 2023 under the chairmanship of His Excellency Faure Essozimna Gnassingbé, President of the Republic. The main topic of discussion was universal health insurance. In line with his policy of social cohesion and harmony, and the promotion and development of human capital, the Head of State has instructed the Government to strengthen and extend social protection to all sections of the population. Universal health coverage, one of the priority projects of the 2020-2025 Roadmap, was enshrined in Law No. 2021-022 of 18 October 2021 instituting universal health insurance in the Togolese Republic.

The Council of Ministers heard a presentation by the Minister for the Civil Service, Labour and Social Dialogue on universal health insurance, in particular the technical parameters for its implementation. The communication reaffirmed the emphasis placed on equal access to essential or primary healthcare, on the quality of care and on solidarity.

It set out practical proposals designed to speed up the process of implementing universal health insurance.  These proposals focus on the basket of services, contribution rates, the architecture of universal health insurance, and the provisional timetable for integrating the various categories of the population into universal health insurance.

The timetable for the integration of the different strata and categories of affiliates into universal health insurance begins on 1 January 2024.  Ultimately, the successful acceleration of the UHI process in our country requires the collaboration and involvement of all: social actors, public authorities, citizens and Togo's technical and financial partners.

Draft decrees to speed up the AMU process

The Council examined and adopted a first decree setting out the universal health insurance reference basket of care for employees in the public sector and workers in the formal private sector.  This text sets out the detailed basket of guaranteed benefits, taking into account the need to provide basic health care and to maintain the technical and financial equilibrium of the scheme.

It defines three groups or categories of people subject to universal health insurance: public servants and assimilated, as well as holders of civil and military pensions, workers in the private sector, holders of retirement pensions in the private sector, ministers of religion, self-employed workers and people in the informal and agricultural sectors, and vulnerable people.  It is specified that the various categories of insured persons may subscribe to complementary care packages.The adoption of this decree will ensure equitable access to essential health care for all sections of the population through universal health insurance. 

The second decree examined sets out the contractual framework between the managing bodies and the delegated managing bodies of universal health insurance. Law 2021-022 of 18 October 2021 establishing universal health insurance in the Togolese Republic provides for the possibility of delegating certain powers and functions of the universal health insurance managing body to delegated managing bodies. The aim is to increase the efficiency of services, bring services closer to users and improve communication between stakeholders.  This decree therefore gives universal health insurance managing bodies the opportunity to draw on proven expertise in the field and to strengthen their proximity to the population. It will make universal health insurance more efficient, faster and better administered.

The third decree sets out the terms of access to health care services covered by universal health insurance.  This decree regulates the conditions under which entitlement to healthcare services is granted, the different types of health facilities available and defines the coordinated care pathway that insured persons must follow.  It provides a framework for access to universal health insurance benefits.

The Council examined and adopted a fourth decree setting the rates, amounts and collection procedures for social security contributions and other contributions due under the universal health insurance scheme.  This decree defines the basis and rates of social security contributions for those subject to the basic compulsory health insurance scheme, and specifies the methods of payment and collection, defined and adapted according to the particularities of each category or group of taxpayers, taking into account in particular the nature of their income.  For people in the vulnerable category, a flat-rate monthly contribution is proposed, the amount of which will be set at a later date.

The adoption of this decree provides the AMU management body (INAM and CNSS) with the necessary legal instruments to effectively begin implementing universal health insurance.It also makes it possible to establish equitable financing that takes into account everyone's ability to pay.

Gamé KOKO