Too many people still lack access to essential health services, though, the Universal health coverage (UHC) aims at improving health, reduces poverty and fuel economic growth, however, Africa is at critical moment in the pursuit of UHC as a means to achieving Sustainable Development Goals (SDGs).
On 5-7 March 2019, more than 1,500 people – including scientists, practitioners and advocates as well as political leaders and the private sector – from the 49 countries worldwide including 26 Africans, have convened to Kigali, Rwanda for the Africa Health Agenda International Conference (AHAIC) to discuss on multi-sectoral action to achieving UHC in Africa.
More than 1,500 gathered in Kigali for Universal Health Coverage
Where Africa stands to achieving UHC
According to figures by the World Health Organization (WHO), Africa that bears 24 per cent of the global disease burden, has only 3 per cent of the world’s health workforce. Only 6 African countries dedicate at least 15 per cent of the annual budgets to the health sector – as committed through the Abuja declaration. Meanwhile, 40 per cent of the total health expenditures in 22 African Countries comes from out-of-pocket payments that lead to the falling into poverty of 11 million every year.
Immunization rates in Africa have stagnated at around 74 per cent in recent years – below the global target of 90 per cent – however, African population is expected to reach 2.5 billion by 2050, requiring focus on long-term inclusive growth.
2/3 of all maternal deaths globally occur in sub-Sahara Africa and an estimated 5 million people die every year in low and middle income countries owing to poor quality of care.
Call for political will
Speaking at the opening ceremony of the AHAIC, co-hosted by Amref Health Africa and the government of Rwanda, Rwanda’s Ministry of Health, Diane Gashumba, called on Africa’s heads of governments to collaborate towards healthcare financing, "Investing in UHC is one of the smartest investments a country can make.”
"In the past two decades, African countries have displayed commendable leadership in furthering the UHC agenda across the continent. We must ensure that this movement is sustained through greater domestic investments in healthcare and that all ministries and stakeholders do their part," She added.
Githinji Gitahi, the Chief Executive Officer of Amref Africa said it’s true that there are many challenges when it comes to realizing UHC in Africa – too many people across the continent lack access to safe, affordable and quality health care and advanced technologies – and as a result, many lives are lost to preventable diseases and treatable illnesses. With strong political will, UHC can become a reality for any African country. “Going forward, we need to galvanise political will at the highest levels of government, mobilise greater resources to eliminate catastrophic health costs, and invest in community-led interventions,” he said.
Though, the journey couldn’t leave young Africans behind, “We are asking ourselves the question of how young Africans who are the leaders of the future, as the majority people in this continent, how are they participating in making sure the UHC is achieved and how is it responsive to the needs of this part of people, especially concerning reproductive health rights and access,” said Githinji.
Linda Mafu, the Head of Political and Civil Society Advocacy based in Geneva, Switzerland said Rwanda is one of African countries leading the rest of the continent in raising funds locally through homegrown solutions. “There is no better example than Rwanda for the rest of Africa to learn how it is important to use the available resources, to be accountable, monitor activities and funding, how grown solutions are deployed to increase local funding. This has been possible for Rwanda because of its political will, leadership and commitment at every level. That is what we want to see from the rest of Africa as we move on in future”.
"National health plans must outlive governments," sharing his experience as a Member of Parliament in Ghana, Hon. Robert Kuganab Lem calls for consistent leadership by health ministries that outlasts changes in government.
Besides African governments failing to implement the 2001 Abuja declaration to funding, healthcare, Civil Society Organisations (CSO) representative were concerned that African leaders show a poor example by getting treated outside Africa.
“When African leaders get sick, they run abroad for treatment but we need to see them seeking treatment in our hospitals, clinics and may be save their countries from spending a lot of money in other countries” Itai Rusike, Executive Director at Community Working Group on Health (CWGH) giving an example from Zimbabwe’s failed healthcare system.
“Our biggest demand is to have funding for HIV/Aids. We need to hear government commitments in fighting the disease because if the American president – Donald Trump – woke up and tweeted closure to their funds, many lives will be affected,” said Aimable Mwananawe, Executive Director of Ihorere Munyarwanda Organisation and a member of the East Africa CSO.
Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization told African leader at the 32nd summit of the African Union (AU) in February this year, that “UHC is not a luxury only rich countries can afford. All countries can make progress with the resources they have”.
Engaging the community
Experts said there is a need of social accountability for UHC which requires engaging citizens in the planning, development, implementation and evaluation of health policies and programming, as well as the accountability and allocation of resources and services.
“Drivers of health delivery in fragile and vulnerable states are often community-based, indigenous providers,” said Profeta Barbara from Swiss Agency for Development and Cooperation in Kenya.
Prof. Francis Omaswa, Executive Director of Africa centre for Global Health and Social Transformation said “Quality in health is unnegotiable and marginalised communities and that is why we need Community health workers (CHWs) to reach the community, who are part of the health system”.
Margaret Kilonzo, a CHW in Kenya said, “CHWs are critical at the community level to provide a number of health services including immunization, maternal and child health care at the household, simple things like handwashing”.
At the 32nd AU summit in Addis Ababa, the new Africa Health Financing initiative has been launched, within which African governments, business and global health leaders call for increased investment in health and the USD200m in public and private sector commitments announced.
However, the Africa Medicine Agency (AMA) which was supposedly be approved by head of states at the same summit, hasn’t appeared on Agenda. On March 5, Githinji Gitahi told DTE “The AMA involves political aspects as countries looks individual interests, thinking the Agency can decrease their revenues,” adding only the framework has been approved.
Speaking at the African Leadership Meeting on Investing in Health which took place at the same AU Summit, President of the Republic of Rwanda, Paul Kagame – Who has been Awarded by Amref Worldwide at the opening of AHAIC on Tuesday for promoting UHC in his country – has urged governments and members of the private sector from across Africa to work more collectively to fund healthcare systems on the continent.
“Governments should surely be willing and able to increase domestic investment in healthcare,” he said adding countries should be the first ones to contribute to efforts that directly benefit African people.
Minister Diane Gashumba receiving the award on behalf of the President Paul Kagame