Sana'a, Yemen - Started in 2005, ILOs work on social health protection in Yemen focused on exploring ways to extend social health protection. To this extent, after a mission to Yemen in 2005 the project was kick-started with a pre-feasibility study to examine how social health protection and access to health services can be improved for the poor. The aim, in particular, was to examine whether community-financing mechanisms might help to improve access to health care. Lack of access to health care exists in Yemen for the following main reasons:
- high cost of health care (especially high direct costs);
- lack of availability of medicines;
- maternal and child health care especially require attention (due to issues of gendered access to health care, where women choose to forsake health care in order not to inconvenience anyone);
- low quality of health services.
In addition to this, like many low- and middle-income countries, the majority of the population in Yemen faces the problem of an access deficit. While 85% of its population resides in the rural area, the majority of the available health care is situated in the urban areas. Significantly, while the ratio of qualified health personnel to the population has been rising in recent years, inadequate staffing of health facilities is also an important concern.
ILOs activities in Yemen have looked at extending social health protection in the face of these challenges, with the idea of addressing the financial barriers in particular through implementing community based financing initially. ILOs above activities regarding extending social health protection in Yemen suggest that conditions are in place for effective community financing. Community financing is a building block towards enhanced social protection in health. Alongside the strengthening of the current tax-financed public health service, commercial health insurance, Social health insurance and Community financing provide opportunities to increase access to care and financial protection. Community financing is especially useful to target population groups active in the informal economy. These groups are typically amongst the poorer segments of the population.
The core conditions for community financing are in place in Yemen, at least when the analysis is applied at the national level. However, there is wide variance in local-level factors such as the quality of available care, the degree to which local communities are closely-knit and households' financial resources for health. This indicates that the feasibility of community financing schemes can only be locally confirmed. Undoubtedly there will be some localities where community financing is not an element of a solution towards greater access to health care and financial protection.There's but one way to know if community financing in Yemen has a great potential in financing health care and providing social protection: that is to implement the approach in a pilot and then on a wider scale through a nation-wide programme. Pilots in different areas should be documented and learning organised so that practitioners as well as policy makers can draw lessons to increase the effectiveness of extending social health protection in the future.
