Reforms needed to achieve universal health coverage in Africa

This article was originally published in The East African here.

By Evelyn Lirri

Achieving Universal Health Coverage remains a challenge and many countries in Africa may not meet the 2030 goals unless targeted reforms and policy shifts are undertaken, experts have warned.

As part of the United Nations Sustainable Development Goals, member countries agreed to work towards achieving universal health coverage by 2030. Through UHC, countries need to ensure that all individuals and communities have access to the healthcare services they need without suffering financial hardship.

But according to Prof Freddie Ssengooba, a health policy and systems academic from Makerere University School of Public Health, the focus by most countries has been on expanding healthcare services as a means to improve health, which does not address some of the underlying obstacles the health sector faces.

“Universal health coverage requires policy actions in a complex and increasingly multisectoral way. It will require sectors such as health, education, finance and the private sector to work together,” said Prof Ssengooba at a symposium on universal health coverage held in Kampala (Tuesday).

The school of public health through a project called Supporting Policy Engagements for Evidence based Decisions, is currently supporting the government of Uganda to adopt and implement feasible policies that can help the country achieve the coverage.

Prof Ssengooba explained that ensuring access to quality and affordable essential healthcare services for majority of the population should be at the forefront to achieving universal health coverage.

“Health should be looked at in a broader perspective beyond the health sector. We should also focus on social determinants of health such as water and sanitation, environmental protection, nutrition, road safety, and household income,” he added.

Dr Sam Okuonzi, a health policy analyst noted that in most African countries, the funding for healthcare is more inclined to hospital care and services.

“The preventive and promotion health agenda remains substantially underfunded yet it has the potential to reduce the burden of disease and health system costs in the long run,” he said.

This view is supported by Prof Bart Criel, who heads the Equity and Health unit at the Institute of Tropical Medicine in Belgium. According to Prof Criel, universal health coverage cannot be achieved without investing first in primary healthcare — which is often the first point of care for majority of the population.

“At community health level, having strong village health teams who can provide preventive healthcare is critical,” said Prof Criel.

The WHO notes that an estimated 11 million Africans are pushed into poverty every year resulting from medical expenses incurred, as majority of the public pays for healthcare through out-of-pocket expenditure.

While Rwanda, Ghana, Nigeria and Kenya have put in place interventions to achieve universal health coverage through financing mechanisms such as national and community health insurance schemes, most of sub-Saharan Africa continues to grapple with the challenge of how to raise finances for its health sector.

But beyond funding gaps, experts noted that countries cannot achieve UHC without addressing inherent inefficiencies that continue to affect the health system, including poor quality of services, corruption and inadequate human resource.

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