National Council for Universal Coverage (CNCU): Analysis and proposals for optimal health coverage
The National Council for Universal Coverage (CNCU), created by the Head of State by Order No. 21/032 of June 1, 2021, is the subject of an in-depth analysis in this article. While its implementation appears to be laborious and technical challenges arise, it is important to assess opportunities for improvement to achieve the goal of universal health coverage.
It is undeniable that the will of the President of the Republic, Félix Tshisekedi, to achieve global social security, offering health care accessible to all, is commendable. However, the CNCU, as currently designed, appears to lack elaborate and viable resources to ensure optimal coverage.
It is crucial to take into account the technical issues related to the creation, operation and management of the diseases to be covered. Efforts so far seem to focus mainly on making childbirth free, although pregnancy itself is not a disease.
The main weakness of the CNCU lies in the fact that it does not guarantee free care, but rather that payment will no longer be direct so as not to impoverish disadvantaged households. However, it is legitimate to ask what will be the subsequent consideration for these deferred payments. Aren’t the pilot hospitals in danger of going bankrupt given the rigidity of our governments?
Faced with these questions, it is necessary to propose concrete solutions to achieve optimal universal health coverage. In this perspective, the creation of a “Health Fund” could constitute a major support and a reliable execution of the vision of the Head of State.
It should be noted that the service providers and taxable persons of the existing social security funds (CNSS and CNSSAP) already represent more than 30% of the population, which makes them an obvious beneficiary group for such a fund. From these beneficiaries, the action of a Health Fund could extend to the entire population, by levying a legitimate share of taxes in order to strengthen the resources of the institution “National Health Fund”.
Taking the example of the two existing social security funds (CNSS and CNSSAP), which respectively cover active workers, retirees and civil servants, it is possible to envisage the creation of an independent fund dedicated to health care. It is important to emphasize that health care is an integral part of social security and plays an essential humanitarian role.
However, it is crucial to understand that health care is a significant cost and that the resources needed to support this social security “fund” may be less obvious than those of the existing branches in the DRC.. Nevertheless, it is essential to invest material and intellectual efforts to achieve a fusion of technical data on providers and beneficiaries, as well as a fusion of data on financial resources generated by contributors of existing social security funds. This would serve as an initial database for the institution of the national health fund.
In a first phase, universal health coverage could be provided for active workers, retirees and their dependents under the two existing social security schemes (general and special schemes). This approach would make it possible to gradually realize the vision of the Head of State and to respond to global health issues.
In conclusion, it is essential to improve and rethink the functioning of the National Council for Universal Coverage (CNCU) in order to ensure optimal health coverage for all Congolese. The creation of an autonomous health fund, building on the foundations of existing social security funds, can be a solid and viable solution to achieve this objective