Here is our topic for July and August, 2014.
During the last week of June 2014, the government of Uganda convened a National Symposium on Universal Health Coverage (UHC) sponsored jointly with the East Central and Southern Africa Health Community Secretariat.
ACHEST provided Technical support to the two day event. This provided a platform to reflect on issues that African countries face on their way to achieving UHC, and internalize opportunities for achieving this key pillar of the post 2015 global development agenda. How can we simplify the message of UHC so that it is understood clearly, in the same way by all actors?
The key point that came through to me is that UHC is not new. Uganda and other African countries are already on the journey to UHC. It is a mission for a specific vision. The vision is to achieve the highest attainable standard of health and quality of life for all people. The mission is to provide access to fair and affordable quality health care services equitably to the whole population.. The previous and current efforts on Sector Wide Approaches (Swaps), Poverty Reduction Strategy Papers (PRSPs), Comprehensive National Development plans the long term national vision such as Vision 2030 or 2040 are all in reality movements towards UHC. They all envision the creation of conditions in countries that lift the whole
population out of poverty and address issues of equity, social justice, health, quality of life and inclusive growth through the provision of packages of basic health and other social services for the whole population, leaving no one behind. Indeed most national constitutions in Africa have language which calls upon governments to ensure the provision of basic health services to their populations. The questions that need answers in the countries are: what packages of services? for whom?, how to
finance and deliver them? How to organize and provide social safety nets for all?
Let’s address each of these in the reverse order. Delivery mechanisms are the most challenging to identify and implement. In order for them to work effectively, they must first and foremost be owned by the beneficiaries both in design and implementation. Ownership and leadership of the UHC initiatives by the heads of governments and state is critical and this ownership and leadership then cascades all the way down to the communities and households. Responsibility for the national health agenda under UHC is a matter for the entire population and should be embedded in the way that society is governed and implemented not by health professionals alone but by all the arms of government and society, crossing culture, religion and socio economic status. Contracting, regulating, supervising, quality assurance of service providers and fund managers; as well as management of payers and users, l all pose real challenges that need to be overcome collectively. Therefore for all this to happen, UHC has to be part of an ongoing national dialogue over which political elections are won and lost.
It was instructive to listen to the Ministry of Gender Labour and Social Services in Uganda articulate their vision for social protection, responding to social needs, providing direct support and promoting
national awareness for social support needs.
It will be critical to cost the packages of services for UHC so as to appropriately mobilize adequate financing for them. African households contribute 40 – 60% of total health expenditure as “out of pocket at the time of need”. Other sources are tax revenues, health insurance and community based contributions and external donors. Financing UHC is often misunderstood to mean health insurance, but it is broader than this. It is more about organizing and integrating multiple diverse sources of health finance into funding pools to guarantee access to healthcare for all, at minimal or at no cost to them, at the time of use. Some developed countries use a fully tax-revenue based approach or payroll based health insurance but in Africa most countries use the mixed approach. At the Kampala symposium it emerged that some have proposed to make offers of in-kind contributions such as of bananas, maize, milk and other local produce contributed by rural populations during harvest time to support contributory coverage schemes. Persuading households to pool resources is only possible when there is ownership by them and when the management is competent and trusted with services actually accessible when needed.
The identification of the package of health services and targeting population groups is once again determined with the beneficiaries based on felt needs and available evidence. The process of ongoing national dialogue needs to be evidence based which introduces roles for academic and research institutions that need to be an integral part of UHC. Africa is already on the road to UHC, the speed of travel needs to be accelerated through awareness creation to drive increased demand, as well as
committed and competent leadership at all levels. The UHC agenda is broader than the health sector. To ensure success, it is critical to actively engage all actors in society, all sectors in the economy and that
driving the agenda is led by heads of governments. Successful implementation of UHC creates a unique social dynamic that is good for society.
How can Africa accelerate progress towards UHC?
This topic is at the heart of all our efforts. It would be immensely helpful to receive comments from all of you; both in Africa and developed countries.