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Universal Health Coverage – Unprecedented commitment in Eastern and Southern African Countries. Is it time to rejoice?

By Juliet Nabyonga-Orem
on January 15, 2019

The commitment to Sustainable Development Goals (SDGs) lays the basis for a renewed momentum to ensure health for all. Within the SDG agenda we associate ‘Health for All’ with Goal 3: “Ensure healthy lives and promote wellbeing for all at all ages”. Since the endorsement of the SDGs in 2015, we have realised multiple commitments at global, continental and country level to attain Universal Health Coverage (UHC) and so perhaps we should rejoice that at last we are on the road to health for all by 2030. Let’s try to find out in this blog whether this feeling is justified.

At the global level, the UHC 2030 International Health Partnership commits signatories to the global compact to ensure that no one is left behind; transparency and accountability for results; a clear health sector strategic vision with government leadership; collective action in strengthening the health system and international cooperation based on mutual learning across countries. The global health community is also already looking forward to the UN High-Level meeting on UHC, end of September in New York, an event that will surely provide even more momentum to the UHC movement.

At the continental level, the sixth Tokyo International Conference on African Development (TICAD VI) conference held during August 27-28, 2016 in Nairobi – Kenya, committed African government leaders and partners to strengthening their health systems to attain UHC.. The World Bank publication “UHC in Africa: A Framework for Action” (2016) makes a case for investing in UHC asserting that it is a moral obligation as well as a good investment with positive returns in terms of human productivity, poverty reduction and economic growth.  The African Union call to action “Universal Health Coverage in Africa: From Concept to Action” (2014) reaffirmed the commitment of the African States setting a more ambitious target of 2025 for Member States to attain UHC. Like in the rest of the world, Dr. Tedros, the Director General of WHO has engaged Heads of State in Africa, as well as Ministers of Health and partners, imploring all of them to work towards attaining UHC for their populations while emphasising the crucial role of political commitment, prioritized domestic financing for health and context specific approaches. His recent visit to Kenya related to the launch of the UHC road map attests to his commitment and indeed in his meeting with President Uhuru Kenyatta and the Kenya team, he stated that You all know how passionate I am about UHC. I want to see what the Kenyan government is doing to ensure it is achieved.” At the WHO African Region level, Dr. Matshidiso Moeti’s commitment to UHC is evidenced by her engagement with the Ministers of Health.  During the sixty- seventh WHO Regional Committee for Africa held 28 August-1 September 2017 in Victoria Falls, Zimbabwe, the African Health Ministers of the 47 member states committed to attaining UHC and endorsed a Framework for health systems development towards UHC in the context of the Sustainable Development Goals in the African Region. Dr. Moeti further launched “The Africa Health Transformation Programme, 2015 – 2020 – A vision for Universal Health Coverage” whose goal is to ensure  universal access to essential health sciences in all member states of the WHO African Region.

Turning to the Eastern and Southern Africa subregion, then, we continue to witness an unprecedented commitment to UHC. Nine out of the 20 countries in the subregion are signatories to the UHC 2030 Global compact. Seven out of the 20 countries have developed consensual multisectoral UHC roadmaps in a highly participatory manner. Further, some countries have witnessed national level launches of their UHC roadmaps as well as events to mark “UHC day” (12 December) with extensive media coverage. By way of example, South Africa’s President hosted a Presidential Health summit  19th – 20th Oct 2018 which brought together over 600 delegates. The major aim of the summit was to galvanise stakeholders’ efforts to tackle challenges in the sector and collectively define a roadmap towards UHC, demonstrating high level political commitment to UHC. The summit agreed to develop a Presidential health compact to ensure implementation of agreed recommendations.  While closing the summit, the Deputy President stated that “May this be the beginning of a rich and fulfilling journey towards a transformed, accessible, equitable and quality health care system in South Africa”.  Similarly, in Kenya, President Uhuru Kenyatta launched the “UHC Road map” for the country and remarked that “Today marks a key milestone; a historic journey for our nation as we inch closer towards the realisation of health for all”. He reiterated his commitment to ensuring that all Kenyans enjoy the highest level of health as provided for in the constitution and, situated good health in the socio economic development agenda of the country. Indeed UHC is one of the key ingredients of the President’s “Big 4 agenda” for development, the others being food security, affordable housing and manufacturing. Uganda has also witnessed high visibility of UHC events with extensive media coverage.  

Admittedly, all these high level events for UHC allude to the (many) challenges that must be tackled on the journey towards UHC – most of these have plagued health sectors within the African Region for over a decade. The low investment in health, inadequate and inequitably distributed human resources for health, fragmented health information systems, weak infrastructure and medicines stock outs are hurdles to overcome. Limited fiscal space has been a major challenge to increasing domestic financing for health in the majority of African countries but the projected positive economic growth in Sub-Saharan Africa forecasted to rise from 3.1% in 2018 to an average of 3.6% in 2019–20 offers a ray of hope. However, considerable variations across countries must also be highlighted in this respect. This notwithstanding, the message has consistently been that all countries, irrespective of their level of economic development can work towards UHC. Indeed Dr. Tedros asserts that “Universal Health Coverage is a political choice. It takes vision, courage, and long-term thinking”. He’s damned right.

We must admit that countries making commitments at global, continental and national levels is not a new phenomenon. For example, the Abuja declaration committing African countries to allocate 15% of the national budgets to health dates as far back as 2001 but by 2014, only 4 countries had attained this target on the continent. The same could be said of the Maputo declaration on HIV/AIDS Tuberculosis, malaria and other related infectious diseases (2003); the Algiers declaration of health research (2008) and several others. So more than a few observers might wonder whether this time will be different. Currently, however, we are observing a trend that we have not witnessed before and this gives us a reason to rejoice.  National launches, extensive media coverage, presidential summits, presidential compacts to ensure accountability and monitor progress and consensual intersectoral plans send a ray of hope and for these we rejoice.  At the start of a new year, we’re sure you understand!

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