On 20 June, the Government of Mali adopted a bill on Universal Health Insurance (RAMU in French). RAMU is a new social protection system in health that aims to provide the Malian population with a single health insurance scheme.
Mali is one of the worst countries in the world for children. One of the causes of the high rates of both maternal and under 5 mortality is low access and utilization of health services because of financial barriers (45% direct payment or Out of Pocket).
This new bill, if fully implemented, should benefit mainly people from rural areas and the informal sector (the informal sector or grey economy is the part of an economy that is neither taxed nor monitored by any form of government) who are currently poorly covered (6% in 2016 through Insurance companies, compared to over 70% in the formal sector). This is an important step towards saving thousands of women and young children by 2030. However, to achieve this, the Government needs to mobilize US $160 million from its domestic resources in order to cover 80% of the basic health package of the population, in order to increase the health insurance rate from 12% to 31% in 2023.
The road to success
From 2012 to 2014, Save the Children through our EVERY ONE global campaign, started campaigning on the lack of social protection for vulnerable groups (children under 5, pregnant women, informal sector) and the link between the high rates of child and maternal mortality and the financial barriers. We strengthened capacities of Members of Parliaments, technical agents of the Ministry of Health (MoH) and Civil Society Organisations (CSOs) on Universal Health Coverage, Health Financing. By 2015, we supported the Ministry of Solidarity to formally set up a National Reflection Committee on the realization of Universal Health Coverage by reviewing three existing schemes, which were fragmented and inequitable.
By September 2016, we had teamed up with the World Health Organization to organize a capacity-building workshop for the Group of 33 National Experts created to assess the existing policies and schemes, and work on the draft of the new bill.
At the same time, we supported the creation of a CSO platform to advocate for Universal Health Coverage. This platform carried out key lobbying activities aimed at the Prime Minister and donors to put pressure on the government. Finally, in May 2018, Save the Children actively lobbied the Government of Mali, at the national level and in Geneva, prior to and at the 71st World Health Assembly, to make a commitment regarding the bill’s adoption, which finally happened a few days later on 20th June 2018.
Following the bill’s adoption, our youth leader, Ms. Fatoumata Sangaré, former President of the National Children’s Parliament and former Chairwoman of our Every Last Child Campaign National Steering Committee, stated, "I do think that this is a very good thing because it will help reduce the issues around care (access) for patients, women and children mainly. And when we speak about reducing issues of care, we are speaking about saving lives. This will encourage more people, especially in remote areas, to go to health centers."
The next steps
The adoption of the bill by the government is one of the most crucial steps towards achieving Universal Health Coverage. However, we should also be aware that this just the starting point of a process and now we must focus on its implementation. The next steps in the short term are:
- The submission of the bill to the National Assembly for adoption in the coming weeks or months
- The announcement of the Law by the President
- The adoption of the implementation texts which should specify who will benefit totally or partially (80%) from which health package
At each of those stages, Save the Children and its civil society partners will remain alert to ensure that children under 5 and pregnant women will be at the heart of this policy in order to consequently reduce child and maternal mortality as per Sustainable Development Goal 3.