Universal health coverage in Africa

The fourth plenary session of the Forum (Wednesday 19 September, starting at 9:00 AM) served to put EDCTP-funded research on poverty-related diseases in the broader context of the Sustainable Development Goal for health.

It is important to consider action against infectious diseases in the broader context of global health and of universal health coverage. Dr Juliet Nabyonga Orem, of the WHO Regional Office for Africa, focused on progress towards the third of the sustainable development goals (SDG3) – ´to ensure healthy lives and promote wellbeing for all at all ages’. She emphasised that progress made within one SDG is linked to performance within others; thus working towards the political, social, economic and environmental targets will positively impact on the health targets within SDG3. Conversely, gains in health will be of benefit to, for example, the economy.

Target 8 within SDG3 is the achievement of ‘universal health coverage’ (UHC) – all people should receive the essential health services that they need, without being exposed to financial hardship. To assess the level of progress within countries we need to ask who is covered, for which services, and whether people have to pay out of pocket. We must progressively extend coverage, reduce costs, and add additional services. Resources are limited, making it necessary to choose how much is devoted to each of those three areas.

She compared the level of progress made in different African countries in a fascinating slide that divided African nations into four categories as to whether service level was low/high and whether costs were low/high.

She identified the following as persistent challenges:

  • improvements are not uniform within and across countries
  • funding improvements are not uniform or sustainable
  • new and re-emerging health threats
  • persistent health system gaps.

Other factors include demographic changes; the population is rising overall with a ‘youth and elderly bulge’. African economies are growing but this growth is fragile and inequality is rising. Security concerns exist in many African countries. Urbanisation, changing social norms, and more knowledgeable people (who demand better health care!) are also part of the picture.

The WHO regional office is working with countries to aid their UHC efforts. It advocates adequate planning across all cohorts and not just in the health sector, and including monitoring to link targets to actions. It will be essential to improve governance: health ministries need to be both providers and stewards of the health agenda, they should build institutional capacity, and provide both leadership and governance.

Primary health care has been a focus for a long time now. Primary health care is still valid and good value for money, but more than basic care is needed. We need effective oversight, appropriate regulation and incentives, accountability, better system design, and coalition building. To do this we need to strengthen the evidence base, which will require building research capacity

Areas on which African countries should focus on include: policy dialogue, the alignment of policy/planning to the multi-sectoral nature of the SDGs, and the creation of data systems.

She closed by quoting WHO’s Director General, Tedros Adhanom Ghebreyesus, who has described universal health care as a political choice, which he says will need both courage and long-term thinking.

Comments from the floor were made to the effect that ‘out-of-pocket’ issues can affect everyone (it is not unknown for fairly well-off people to sell their homes to be able to afford treatment), and that WHO needs to find new ways to interact effectively with governments to see that they ‘get the message’.

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