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Health insurance in the aftermath of Ebola

Research from a City, University of London academic advised Sierra Leonean health care policy in the aftermath of the Ebola virus.

Almost 4,000 people died during the Ebola crisis in Sierra Leone between 2014-15.

The enormous socioeconomic disruption had left Sierra Leone with a fragmented health care system and one of the highest rates of out of pocket expenditure in the world. By 2016 a national health insurance scheme was the top priority for the Sierra Leonean government.

Research from a City, University of London professor advised on changes to health care policies, introducing an affordable protective health insurance scheme to Sierra Leone.

What did we explore and how?

In a series of papers related to health care provision, Professor Mireia Jofre-Bonet’s work advised Sierra Leonean officials in the design and enactment of the health insurance scheme for the informal sector which was rolled out in 2018.

Professor Jofre-Bonet’s papers found that mixed healthcare provisions may increase quality of both public and private health care suppliers and benefits welfare.

Through mass surveys, her work also identified the maximum willingness to pay (WTP) in healthcare provision and that households were WTP more for better coverage, less waiting time and for faith-based health care providers.

The various analyses showed that a premium could be set at approximately 20,000 SLL ($3.54 USD) per month. Professor Jofre-Bonet’s work identified that a single premium set too high would jeopardise the participation of certain groups and risk pooling

Benefits and influence of the research

Two academic papers that incorporated Professor Jofre-Bonet’s work helped to shape the idea of a National Health Insurance Scheme in Sierra Leone.

The immediate result of her research adapted a healthcare system which had some of the highest rates in the world in infant and maternal mortality and depended completely on external support.

Her work helped to determine how much informal sector individuals were willing and able to pay for health insurance and shape the frequency of payments.

In October 2016, Professor Jofre-Bonet held talks with the Minister of Labour and Social Security; the Director General of the National Social Security and Insurance Trust; the Minister of Health and Sanitation; members from the World Health Organisation (WHO) the Overseas Development Institute fellow in that country.

These talks identified the barriers for a health insurance scheme in Sierra Leone due to the persistent lack of funding for medical staff and the crippling effects of the Ebola crisis.

The research supported policy makers in accommodating changes that would be needed to introduce a health insurance scheme.

Professor Jofre-Bonet’s work improved conditions for informal sector workers who were paying large amounts of money out of pocket for their ad hoc health care needs. The resulting changes to policy saw them pay an equivalent of $2 USD a month to access the insurance scheme for primary care. Those in the formal sector would pay 6 per cent of their salaries and children under 12, elderly people and people with disabilities would receive free healthcare.

The researchers

Professor Mireia Jofre-Bonet

More about this research

  • School of Arts and Social Sciences
  • Related academic: Professor Mireia Jofre-Bonet
  • Status: Completed
  • Topics: Health
  • Industry/sector: Health and social care