Universal Health Coverage a worthy goal to strive for
The road to its implementation will be a challenging one
THE topic of Universal Health Coverage (UHC) is indeed a weighty one and in the African context even more so, given the challenges and opportunities that arise in considering and implementing it. The high personal cost to citizens who must pay excessive fees for quality health-care services is well known and the point of UHC is to prevent financial hardship to citizens. It is a worthy and noble goal, which we need to strive for.
There is a significant body of research into this subject, and many learned colleagues, including academics, health-care workers, public servants are grappling with this matter in depth.
My few remarks today, which reflect on some key learnings in the global context, will hopefully contribute to taking the agenda forward on the implementation of UHC in Africa.
I spent 10 years in medical practice and of course, the issues of access to, and affordability of, good quality health care for citizens occupied me then daily as a medical doctor.
When I began practicing, in the 1980s times were indeed dark in apartheid South Africa – and access to quality and affordable health care was difficult, to put it mildly, for the majority of our citizens.
South Africa has made much progress since. Our first democratically elected president, Nelson Mandela, whose centenary we celebrate this year, first introduced free prenatal and antenatal health care for women and children up to the age of six in the public health-care system in 1996.
This was one of his flagship projects. In doing so, he demonstrated his vision and understanding of the importance of accessible health care as one of the key pillars in building the nation, social cohesion and a productive and democratic society.
We continue to be inspired by the legacy he bequeathed us. That this conference on UHC takes place in South Africa in the year of Madiba’s centenary is noteworthy.
Sustainable Development Goal (SDG) 3 calls for the ensuring of healthy lives and well-being for all by 2030. Point 3.8 specifically calls for the achieving of “universal health coverage (UHC), including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential vaccines for all”.
All member states of the UN have in principle agreed to the implementation of UHC by 2030, in line with the SDGs. However, according to the World Health Organisation (as at December 31, 2017) approximately half of the world’s population still does not have access to essential health services. About 100 million are driven to live in extreme poverty because of having to pay for health care and more than 800 million people spend a minimum of 10% of their budget on health care.
These statistics indicate quite clearly that the road to its implementation will be a challenging one.
Therefore, it is encouraging that the prioritisation of this SDG has been referenced by world leaders at the G20 Summit in 2017 and will remain high on the agenda for both governments and civil society until 2030, when this milestone is expected to be achieved.
In the context of Africa, the African Union – Agenda 2063 lists as one of its aspirations, to have a continent free “from fear, disease and want” and that by 2063, the people of Africa should have “sound health and well-being”.
While timelines differ between the SDGs and the Africa 2063 agenda, the aspiration to achieve optimum health and well-being for citizens is a clearly stated objective of both these guiding documents.
Of course, the research demonstrates that where health-care needs of citizens are satisfactorily met, it facilitates higher economic participation
It will require political commitment, especially at government level, to seek the necessary solutions and partnerships to place citizens at the centre of the equation
and productivity. Those of us who run corporations or institutions are all too aware of the high cost of absenteeism because of ill health of employees and the challenges that this presents.
More countries are actively pursuing UHC, and undoubtedly the support provided by the SDGs, Agenda 2063 and the drive by world leaders, adds impetus to this pursuit.
There are numerous examples of the implementation of UHC in the world and, for the most part, none of them use the same model, although they may share similar features.
Undoubtedly, the issue of approaching UHC could be served by framing a set of principles that guides countries that are still to embark on or are still completing this journey. Even for those who have already implemented UHC, a constant process of review to measure stated objectives, is advisable.
The Biophamaceutical Industry (which includes the European Federation of Pharmaceutical Industries and Associations and the Japanese Pharmaceutical Manufacturers Association) proposed principles in 2014, within which to frame the pursuit of UHC which has resonance with the discussion here today. The achieving of the objective of implementing UHC will require the involvement of multiple stakeholders and a collaborative approach.
There is an African proverb which states “If you want to go fast, go alone, if you want to go far, go together”. This collaborative approach is important given the many challenges that confront developing countries, and in the context of our discussion today, countries in Africa. These challenges include:
How UHC is funded – because there are many demands on the public purse, this calls for innovative approaches to funding UHC with a diversity of funding options which include, for example, public-private partnerships, health insurance etc.
Public health epidemics – for example, cholera and ebola. This has not yet been fully eliminated, with an outbreak in the DRC in 2018.
The ratio of health care providers to the population – at any given moment.
The ever-increasing need for health-care services as populations increase.
The impact of war and conflict – there are several countries in Africa experiencing war or conflict – including Algeria, Cameroon, Chad; the DRC and Sudan – which also results in millions of displaced people.
The impact of the world economic situation – what happens on the world economic stage impacts all countries.
Given all these challenges, the objective of achieving UHC will not be easy but it is not insurmountable.
However, it will require political will and commitment, especially at government level, to seek the necessary solutions and partnerships to place citizens at the centre of the equation and to face the challenges head-on.
To conclude with a quote from the venerable Nelson Mandela: “After climbing a great hill one only finds that there are many more hills to climb.”