This post is written by Alex Omari, East Africa Technical Family Planning and Reproductive Health Officer, Amref Health Africa and post-graduate student at the School of Government and Public Policy Indonesia.

  • The problem: Countries are struggling with high out-of-pocket expenditure on healthcare which is out of reach for many individuals.

  • Why it matters: Health for all will ensure the attainment of sustainable development.

  • The solution: Enhancing political commitment to increase funding, multi-country coordination, and advocacy by policymakers to ‘risk-pool’ resources to fund UHC.

Introduction

According to the World Health Organisation (WHO), universal health coverage refers to a situation where all people have access to essential health services across the spectrum without financial struggle.

Universal Health Coverage, commonly known as UHC, has been prioritised by WHO whereby there is a target to have the 50% of the world’s population who lack essential services, benefit from UHC by 2030. UHC might have had its journey kick start early as Primary Health Care during the 1978 Alma-Ata agreement on Health for All, but its attainment is another journey.

UHC has two dimensions: access to much-needed healthcare, and financial protection. About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. The delivery of UHC requires an enhanced health system.

Attaining the goal

In efforts to accelerate and realize the UHC target, international organisations, governments, civil society, community organisations, philanthropic foundations and the private sector formed a global partnership dubbed the UHC 2030 International Health Partnership in 2016 during the United Nations General Assembly in a statement announced by the WHO Director-General.

The vision was simple: all countries [should] have a strong health system. The global partnership was made to ensure that countries collaborate through this multi-stakeholder platform, advocate for increased political commitment to UHC, and facilitate accountability and knowledge sharing for evidence-informed policymaking.

The scale of the problem in Sub- Saharan Africa

Globally, countries are striving towards UHC while at the epicentre of Africa’s delicate health systems. The perennial failure is by governments to prioritise health and allocate adequate resources to the sector. Studies by Afegbua (2012), Chimezie (2015), and Agyepong et al (2017) have all portrayed healthcare in many African countries as deplorable, unattractive and irresponsive to the needs of its people, despite the global efforts in providing both financial and technical support.

Africa’s population is projected to reach 2.5 billion by 2050 and it comes with its own fair share of challenges - not ignoring the current high levels of child and maternal mortality, malnutrition, inability to handle epidemics. Developing countries also have limited financial resources and there are disproportionate differentials among the urban and rural inhabitants.

Despite the regional declaration (commonly known as ‘2001 Abuja Declaration’) at the Africa Union for member states to allocate at least 15% of their national budgets to health, a stocktake carried out 10 years later in 2011 indicated that just 27 countries had increased the proportion of their expenditure allocated to health. Only Rwanda and South Africa had met the target. In 2016, the situation headed to a deep end with 19 African countries actually reducing their expenditure on health compared to what they had in 2001.

As of 2021, the other notable countries that have also achieved the Abuja declaration target are Botswana, Burkina Faso Ethiopia, Gambia, Malawi, Niger, Togo and Zambia. The Abuja Declaration was meant to strengthen Africa’s health systems and adequately prepare governments for epidemics but most African countries actually reduced their expenditure on health as compared to what they had in 2001.

A progressive match towards 2030 by South East Asia

A study conducted by Evans et al (2016), in six countries (China, Indonesia, Japan, Singapore, South Korea and Thailand) across East and Southeast Asia revealed that over 95% health coverage has been achieved, a wide variation still exists in service coverage. For instance, Thailand covers medication prescriptions while in China the benefit packages are for inpatient services. In addition, the out-of-pocket expenditure varied from 11.3 % in Thailand to 56.8% in Singapore.

According to the World Health Report of 2010, evidence suggests that out-of-pocket payment that is below 20% of the total health expenditure is a good indication of reduced risk of impoverishment from health spending. In ASEAN, there was a reduction in out-of-pocket expenditure that led to a decline in health expenditure since 2008. However, seven countries had a rate higher than 30%, which has greatly contributed to inadequate investments in public resources.

A very recent study published by Abdur Sarker et al established that the out-of-pocket healthcare expenditure in Bangladesh was 7.7% of the household monthly income while the poorer income group spent up to 35% of their household income on healthcare.

The advocacy and political wing

The World Bank notes that ‘investing in Africa’s health systems is critical for inclusive and sustainable development. Effective strategies and mechanisms are essential in attaining UHC in Sub-Saharan Africa (SSA) yet the region faces a myriad of health issues. Reversing all these challenges requires strong leadership and governance.’

Most of the countries in Africa are known to have integrated UHC in their national health strategies, though these commitments have not been actualised. With the 2030 achievement of the UHC targets, the aforementioned challenges will be eliminated but so far it remains a dream.

The political transitions in Africa have more often led to the same results for years. Young people have been mentored and taken abroad in order to transform the leadership vision, but the system has always failed them. The perennial issues need accountable and responsive health systems.

The turning point - What can be done?

  • Political commitments are needed to safeguard health budgets and increase health spending. A strong political commitment from heads of state is critical and it requires coordinated planning, funding and implementation through a multi-sectoral approach.
  • Policymakers must initiate risk-pooling health reforms to help address the issue of the poor spending a greater portion of their income on health which exposes them financially. The reforms can be in the form of introducing social health insurance schemes in order to attain quality and sustainable health for all.
  • Countries should strive to learn from each other in order to make progress on UHC. Sub-Saharan Africa through the ‘knowledge generation agenda’ can learn from the South East Asian nations to spur progress in UHC.
  • UHC should be based on strong, people-centred primary health care because good health systems are rooted in the communities. It’s imperative to improve well-being and quality of life.
  • Improving health service coverage and health outcomes depends on the availability, accessibility and capacity of healthcare workers to deliver quality people-centred integrated care.

Moving towards UHC is a gradual process and every step counts. Sound health policies and health financing strategies are essential to ensure that no one is impoverished as a result of the costs of healthcare, and that the resources are used efficiently and fairly. There is a need to strengthen leadership and governance in the health system if UHC policy implementation is to succeed.

To make health for all a reality and not a dream, individuals and communities must have access to equitable high-quality health services in order to take care of their own health and the health of their families. Skilled health workers are essential for provision quality and people-centred services and policymakers must heed their clarion call of enhancing their political commitment by investing in Universal Health Coverage.

👋 You can create a post like this one! Share your thoughts with a community of public servants. Learn more

(Image Credit: Unsplash)