Togo: Creation of a universal health insurance system approved

Employer Action Code: Monitor

Legislation establishing the creation of a universal health system (l'assurance maladie universelle – AMU) has been approved by the national assembly. This follows the approval of a new Labor Code in June 2021 (to be effective 12 months after being signed into law), which includes the general right to health insurance coverage for all workers. The government aims to complete the rollout of AMU by 2025, although a detailed plan has yet to be released. Like much of sub-Saharan Africa, government spending on healthcare in Togo is relatively low (about 1.4% of GDP) with out-of-pocket spending representing about two-thirds of all expenditures (World Health Organization data).

Key details

The key aspects of AMU include:

• All residents would be covered by the system, which would be composed of two tiers. Public and private sector employees would be covered by the mandatory régime d'assurance maladie obligatoire de base (RAMO). A separate system would apply to the poor and other individuals on public assistance (régime d'assistance médicale – RAM).
• Under RAMO, employees would be enrolled from the start of employment with benefit coverage extending to dependent spouses and children (up to age 21, with no age limit if disabled or otherwise deemed unable to work). Further extension to other dependents (such as parents) would be possible, subject to the employee covering the cost.
• The cost of coverage would be funded jointly by employer and employee contributions. Coverage provided through RAM would be funded directly by government revenue.
• Insured individuals would be covered for a defined range of covered services (relating to hospitalization, consultations, outpatient care, medication, diagnostic services, medical devices and transportation) for non-work-related illnesses and accidents as well as maternity up to a defined cost ceiling.

Employer implications

The recently approved law only establishes the future system’s general framework, with most of the details on coverage, contribution rates and related topics to be defined by the government at a later date. Employers should continue to monitor the situation as more details about the system and the specific obligations of employers and employees are announced.

The government announced on November 4, 2021, as a first step toward rolling out AMU, that all mayors and municipal councilors who did not already have health insurance are henceforth covered under the new system for 80% of covered medical costs up to an annual ceiling of 3,500,000 West African CFA francs (CFA) (sub-ceilings for certain types of care — such as dental and vision — also apply) and covered for accidental death and disability, providing a lump sum benefit of CFA 5,000,000 in the event of death or permanent disability as well as up to CFA 500,000 for related expenses. The coverages are arranged through a private insurer (NSIA Togo).