How African countries can achieve Universal Health Coverage

A call on African countries to reinvigorate their quest for Universal Health Coverage (UHC) by 2030 rang out from the hills of Kigali, Rwandas capital, a fortnight ago. The event was one of the largest biennial health gatherings in the continent the Africa Health Agenda International Conference 2019 (AHAIC).

To advance the critical conversations initiated in Nairobi, Kenya at AHAIC 2017, 1500 participants from over 40 countries gathered at the Kigali Convention Centre (KCC) between March 5 and 7 for this years conference.

The upbeat mood, buoyed in large part by the ambiance of the event centre, was interrupted by the urgency of seeking ways to tackle the numerous challenges bedeviling the health system in Africa.

Co-hosted by the Ministry of Health of Rwanda and the African Medical and Research Foundation (Amref HealthAfrica), AHAIC 2019 focused on the greatest health challenges facing Africa under the theme 2030 Now: Multi-sectoral Action to Achieve UHC in Africa.

The participants confronted the stack reality that Africa is falling behind in achieving Sustainable Development Goal (SDG) Three, one of the 17 goals set by the United Nations General Assembly in 2015 for the year 2030.

Achieving UHC by 2030 is the central target of SDG 3.8.

Targets of SDG 3 include ending preventable deaths of newborns and children under five years of age by 2030.

However, five children under five years of age are still dying from preventable causes every five minutes in Africa, according to the World Health Organisation (WHO).

AHAIC, now in its second edition, arose from the need for home-grown solutions, innovations, political commitments and lessons from successes and setbacks of other countries in achieving affordable health for all.

Here are some of the talking points at the conference.

Affordable health for the poor and vulnerable

Providing an affordable option for Africas poorest will determine whether countries achieve SDG 3, which is to ensure healthy lives and promote well-being for all by 2030, Githinji Gitahi, CEO Amref Health, explained in his first press briefing.

Financial protections for the vulnerable is embedded in what universal health coverage means by definition, which is a concept that overall looks at how to provide quality health services to people without them struggling to afford it.

Eleven million Africans are pushed into poverty every year by medical expenses, according to the WHO.

In Sub-Saharan Africa, health services are mostly paid for out-of-pocket and those gravely affected already live far below the poverty line.

Universal health coverage is about equity, not equality, Gitahi said. Services must first be built for the vulnerable. With that, governments show that the services are responding to equity.

Poverty and ill health are intimately linked in many developing countries, particularly in Africa where public health services are severely strained. A report by the UK Institute of Development Studies suggests that public healthcare services often provide limited benefits to the poor.

Experts at the conference agreed that achieving UHC would require increased access for the marginalised populations and heightened financial support from both governments and public-private partnerships. It would also require improved health service quality and ways to hold governments and health providers accountable to citizens.

Health Insurance: Learning from Successes and Failures of other African Countries

One countrys success story is anothers gain, just as one countrys loss is anothers lesson.

AHAIC 2019 had both setbacks and success stories. A working and affordable Health insurance and finance mechanism is a major driver for UHC.

Host country, Rwanda and their neighbors, Kenya and Ethiopia were exemplified for advancing UHC through various health financing mechanisms.

In Rwanda, community-based insurance has provided the modern social security we want for our people, Rwandas Minister of State for Primary Health Care, Patrick Ndimubanzi, said.

This health insurance scheme is financed by both the national government and individuals through insurance and fees for services.

Members pay annual premiums at a flat rate based on their economic status, regardless of individual health risks, which can then be used for discounted treatments at community health centers.

Health insurance became mandatory for all individuals in 2008;in 2010 over 90 per cent of the Rwanda population was covered.In 2012, only about four per cent was uninsured.

This scheme increased the number of women delivering in health facilities from 50 percent in 2010 to 90 percent in 2015, Mr Ndimubanzi noted.

In Kenya, government appeared to have a larger plan of achieving UHC by 2022.

UHC hospital insurance pilot project is currently being tested in four regions troubled with high disease burdens.

Since the launch in December 2018, the government has offered free basic health care services to all citizens holding a UHC card which required the presentation of national identification to register and covers anyone in the household under 18.

Today, 75 percent of all residents [in the pilot counties] have been registered and are holding a UHC card, Rashid Abdi Aman, chief administrative secretary at the Kenya Ministry of Health, said. He explained that health programmes requiring registration may need to be adapted for those who lack identification papers.

Rwanda and Ethiopia were recognised for their exemplary efforts to expand health care access to their population.

While President Paul Kagame of Rwanda received the UHC Presidential Champion Award, Amir Aman, Ethiopian Minister of Health, got the UHC Ministerial Champion Award.

Setbacks: The Nigeria story

All I had built in the scheme now goes down the drain. It hurts, said Dogo Muhammad Waziri, Past Executive Secretary, Nigerias Health Insurance Scheme (NHIS) in an emotional outburst.

Mr Dogo was a panelist at the side event at the conference organised by the Development Research and Project Centre (DRPC) in collaboration with the National Institute for Policy and Strategic Studies, (NIPPS) the groups that led the Nigerian delegation.

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