In Rwanda & Uganda & Zambia....
this article is from 2007, but here's a more recent one from 9/08..with an update on how they are doing
http://www.thestar.com/News/GlobalVoices/article/507998http://www.blackcommentator.com/246/246_healthcare_here_rwanda_ruxin_guest.htmlsnip
Several years ago, the Government of Rwanda, with United States government support, piloted a system called “health mutuelle” that is essentially a community-based health insurance program. Pay $2 per year per person for mutuelle plus a co-payment — an insurmountable cost for many families — and you receive subsidized care. However, that subsidy is often not enough. I recently met a woman who was told in advance that she would need a Cesarean section at a local hospital but who simply did not have the funds to cover the 10 percent co-payment of roughly $5. She spent days canvassing friends and relatives to loan her the money, ended up with four IOUs, and had the surgery. The average co-pay in Rwanda is about 40 cents, but in a country where most make just a few dollars each month, that can be enough to keep a sick person from seeking care. You might ask: why in the world does a poor country like Rwanda insist on payments in the first place?
These regressive public health approaches emanate from IMF and World Bank mandates handed down in the 1970s as a reaction to rising health care costs, as well as a group of policies for community financing promoted in 1987 and called the Bamako Initiative.
snip..
The Millennium Villages project supports a Rwandan-managed health center in Mayange where — due to extreme poverty — co-pays are not required and the health mutuelle premium is subsidized (Paul Farmer and Partners and Health have recently adopted a similar approach alluded to in Forbes last week).
The results have been impressive: nearly 100 percent of community members have health mutuelle and consider health care their right. Utilization rates have increased dramatically but staff report that they have not seen a single case of abuse. Government of Rwanda is tracking the pilot closely to help determine how to balance subsidies for the poor against payments by wealthier Rwandans. It’s a challenging situation with great resonance in the United States, where the city of San Francisco just announced a plan to cover all of its citizens through a combination of free and sliding-scale payments.
Hope is emerging in Rwanda and across Africa.
In Uganda and Zambia, co-payments are gone, replaced by universal health care; the effect has been immediate and dramatic. Calls to do the same have emerged in Sierra Leone. While many services still require co-pays and health insurance,
the Rwandan Government has made treatment for AIDS utterly free and is looking at ways to cover payments for the poor, while avoiding a culture of dependency.
snip
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