Summary
1) The NHI initiative is the creation of a one universal scheme for all Gambians.
2) It is aimed at serving mostly the poor and reduce out of pocket expenditures.
3) The Ministry of Finance proves to be willing to lead the initiative. The Ministry of Health leads in terms of technical discussions.
4) A law is being drafted but important issues are yet to be clarified, especially:
a. The scope of the law. It should be enought to have a law that created the scheme & its implementation Agency
b. The Agency line Minister
c. The Agency oversight set up
d. The replacement of targeted exemptions by household income-based exeptions
5) New taxes are considered to supplement contributions. They should be progressive ones. They can be earmarked.
6) The Ministry of Health has a very important responsibility in ensuring the availability and quality of services, especially drugs.
7) Granting health facilities with bank account and support their capacity in financial management should be considered. Adapted public financing management should prevail.
8) The initiative would better start with the poor.
9) It should start as soon as possible, possibly with a pilot. But it will have to go slow in terms of expansion.
10) NHI should be implemented with a national dialogue for ownership and sustainability as it is a society project.