The independent Africa Health Agenda International Conference (AHAIC) Commission has unveiled the State of Universal Health Coverage (UHC) in Africa Report.
The report’s executive summary was released on the first day of AHAIC 2021 conference – a biennial convening of health ministers, private sector leaders, civil society and representatives from multilateral organizations taking place virtually from 8-10 March 2021.
The report highlights the progress made by African countries towards realizing Health for All and details the challenges and opportunities faced by countries in achieving UHC.
Compiled between November 2020 and March 2021, the State of UHC in Africa report takes stock of Africa’s progress in fulfilling commitments made by African leaders over the years, such as the Abuja Declaration (2001), the Africa Health Strategy (2007-2015, 2016-2030) and the Addis Ababa Call to Action on UHC (2019). It acknowledges the impact of colonial legacies, poor governance, and economic challenges on the continent’s health policies and outcomes. It details the performance of African countries on key UHC indicators, including effective coverage with needed health services, financial risk protection and health outcomes.
According to the report, Africa’s health systems are poorly attuned to meet the health care needs of the poor, the disabled and other vulnerable groups, with coverage of essential health care services in Africa being decidedly low: only 48 per cent of the population receives the health care services they need. This means that approximately 615 million people in Africa may not receive the healthcare services that they need.
Quality of health care services provided in African countries is also low and is considered the poorest performing indicator of UHC – when quality of health care services is considered, service coverage scores across African countries are even lower. The report also reveals that coverage of essential services needed by women and girls in Africa is low, with data indicating that between 2015 to 2019, only 49 per cent of African women had their demand for contraceptives satisfied.
Despite the dismal performance on some indicators, a number of data indications were positive. For example, although the proportion of individuals that are pushed into poverty due to out-of-pocket health care payments each year is high, at 15 million people (representing 1.4 per cent of the continent’s population), the number is gradually reducing. Health outcomes in Africa, although low, are also improving.
Despite these challenges, the report concedes that the 21st century has seen African leaders show stronger political will to achieve UHC, creating an opportunity for countries to push for the needle for change. The Commission highlights key opportunities that African countries can leverage to accelerate progress towards UHC, including political will, well-trained and competent health professionals and projected economic growth.
In its recommendations, the Commission proposes several actions to ensure steady progress towards UHC, including re-orienting health systems and health system priorities to respond to population health needs; prioritising and strengthening primary health care as the foundation for UHC; investing in strengthening health system inputs through, for example, boosting the number of skilled health workers especially in primary health care; investing in health technologies to enhance the performance of all health system functions and strengthening governance and accountability.
Speaking after the launch of the report, Dr. Githinji Gitahi, Global CEO, Amref Health Africa, said: “Through the State of UHC in Africa report and AHAIC 2021, we are hoping to provide a realistic roadmap that will guide African countries on their journeys to UHC and to ramp up support for greater multi-stakeholder collaboration across the continent, so that we can move from rhetoric to sustained action.”
In addition to the report launch, the first day of AHAIC 2021 also saw attendance from H.E. Uhuru Kenyatta, President of the Republic of Kenya, who in his opening remarks urged African countries to consider seven priority areas to anchor their health policies and programmes, including giving greater priority to primary health care; increasing access to health care services; making health care more affordable; harnessing Africa’s innovative energy and creativity; strengthening health sector collaboration; improving health security and increasing political will towards UHC.
The World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus, highlighted the COVID-19 pandemic role in highlighting the centrality of health to the social and economic wellbeing of African nations. He called on leaders to boost their nations’ capacities to enhance disease prevention and preparedness to mitigate the impact of disease outbreaks through greater political commitment.
Prof. Francis Omaswa, Executive Director of the African Centre for Global Health and Social Transformation (ACHEST) and AHAIC Commissioner was a panelist on the first plenary of the conference that explored the themes of leadership, health policy and investment in UHC.
Prof. Omaswa said this conversation gives Africa an opportunity for Africa to make a new beginning like it was at independence time. “UHCs and SDGs present us with another opportunity to close that gap which exists between Africa and the rest of the world,” he said.
“We need to regain our self-belief. We need to regain our ambition; a new mindset which feels pain and shame at Africa lagging behind the rest of the world in terms of development indices,” said Prof. Omaswa, stressing that investing in heath is the best investment.
“We need to come back with a new brand; a new paradigm in leadership. We need to get mutual accountability between the people and the government and those who generate knowledge. Dr. Tedros says the link between scientists and politics is important. That is it,” noted Prof. Omaswa.
He explained that this partnership is in the form of a triangle, namely:
(1) People (what are their needs),
(2) Knowledge generators (academia and research centers and CSOs answering the question of what do people need and how do they get it),
(3) politicians to implement what the knowledge generators have done to answer the needs of the people.
Prof. Omaswa also explained that social justice/humanity is what is needed to achieve UHC. However, to make social justice practical, there was a need to engage and empower communities to hold duty bearers accountable.
He narrated that at the height of HIV infection, it is the people who were affected who made it uncomfortable for everyone until they got ARVS.
“What they did was to influence the political leaders and data generators that ARVs work. Remember that triangle. At the UN General Assembly in 2001 someone claimed that Africans cannot take ARVs because they tell the time by sun and therefore would mostly likely not take medication appropriately. But our own people in Africa demonstrated that the most loyal ARV takers are here in Africa.”
“The current challenges, are malaria, maternal and neonatal mortality. The indices have stagnated and even getting worse. So, where is the leadership to sort it out? By engaging communities. Let us create community health systems, have a village health committee in every village and let’s put community health workers as members of that village health committee, so that mothers there can talk about how to access skilled birth and other issues affecting them,” explained Prof. Omaswa.
To get the affected people to hold duty bearers accountable, intersectoral collaboration and a whole of society approach is important.
“Our anger and outrage is lacking when we know what is happening! I would like to call on our African professional associations of women doctors and pediatricians. They are treating dying mothers and children every day and they are not getting together to get the parliaments to act. I would like to push for switching on the affected, creating village health committees in every village and then getting the professional groups of all types to be saying their thing. So that triangle and getting the politicians to put their money where it is needed should be the new paradigm moving forward,” Prof. Omaswa stressed.
Compiled by Carol Natukunda