Toward universal health coverage
Health is widely considered to be a fundamental human right, yet the sad truth is that far too many people around the world still do not have access to basic health care.
The answer to this problem is clear: universal health coverage (UHC). For too long, the idea of achieving universal health coverage in Africa was perceived as a distant dream. Fortunately, the tide is turning.
This year, the international community formally enshrined universal health coverage in the new Sustainable Development Goals (SDGs), which will guide development efforts through 2030.
In short, as we celebrated the second-ever Universal Health Coverage Day last week, it was apparent that the movement for health for all has reached a critical mass. The global community clearly recognises that UHC is right, smart and overdue. While our collective commitments to UHC are promising and should be celebrated, now is the time to get serious about taking steps to achieve it.
In Africa, the Ebola epidemic showed us the ‘worst case scenario’ when health systems are weak or broken. Even in the absence of a major health crisis, many African countries struggle to deliver quality and affordable health services. For coverage of several basic health services—including family planning, immunisation and improved sanitation—sub-Saharan Africa lags well behind the rest of the world. The region accounts for approximately 25 percent of the world’s disease burden, yet it has just 3 percent of its doctors. Furthermore, too many households across the continent are forced to borrow money or sell assets to pay for health care.
Countries in Africa that have reached middle-income status face particular challenges. For example, many have lost the preferential prices for vaccines and essential medicines that they received as low-income countries. These countries must find ways to shift the burden of increased costs from the individual to the collective by raising more money for health services and medicines.
To confront the region’s challenges, we can look to and apply lessons from the many African countries taking the lead in implementing UHC reforms, such as Rwanda, Ghana and Ethiopia.
In Ethiopia, a Health Extension Program has trained and deployed over 38 000 health workers since 2003 to deliver primary health care services in rural communities. This program has been essential to expanding access to primary health care. Its success—made possible by commitments of the Ethiopian government, partners, and of course dedicated health workers—has demonstrated the importance of investing in human resources for health and delivering essential health services at the community level.
In Ghana, a tax-funded national health insurance system, known as the National Health Insurance Scheme, covers 95 percent of diseases that affect Ghanaians, enabling financial protection and expanding coverage. This system is an example of the type of reform that can help countries minimise catastrophic out-of-pocket health care costs that all too often lead to poverty.
Of course, there is no ‘one-size-fits-all’ approach to achieving universal health coverage. Each country should develop its own.
However, if we expand and build on the tremendous progress already happening across many countries in Africa and adopt an integrated approach to advancing health for all, I am confident the benefits will be widespread.
I have made universal health coverage a key priority during my tenure as the World Health Organisation’s (WHO) regional director for Africa. I urge African governments and their partners to do the same. n
