Africa: What Africa Needs to Achieve Universal Health Coverage

While many African nations have made commitments to achieving UHC and have implemented various health policies and programmes, challenges persist.

Universal Health Coverage (UHC) is a global health goal aimed at ensuring that, by 2030, all people have access to the essential health services they need without suffering financial hardship. While many African nations have made commitments to achieving UHC and have implemented various health policies and programmes, challenges persist.

PREMIUM TIMES reporter, Nike Adebowale-Tambe, sat with Lolem Ngong, a global public health expert at the just concluded International Conference on Public Health in Africa (CPHIA) to discuss Africa’s push to achieve UHC by 2030. Ms Ngong is also the Chief of Staff to the group of CEOs of Amref Health Africa.

PT: What are the key challenges hampering the efforts of African countries in achieving Universal Health Coverage?

Ngong: We only have seven years to attain Universal Health Coverage (UHC) and the African region still has lots of work to do. In 2016, the World Health Organisation (WHO) announced the ambitious goal of attaining UHC by 2030 in support of the Sustainable Development Goals. To date, most of our African countries have made strong commitments/declarations on UHC, but very few have a clear strategy and have created the fiscal space necessary to reduce financial barriers to the attainment of UHC. We are far from our goal.

On this continent of 54 countries, not even 25 per cent may attain UHC by 2030. Our continent is host to 17 per cent of the world’s population, yet we still account for 23 per cent of the global disease burden; only 48 per cent receive health services and access is not equitable. One of the major challenges in achieving UHC is health financing. The region has not been successful in creating the fiscal space necessary for our countries to increase their domestic resources to finance the attainment of UHC.

UHC, at its core, relies on health financing which means that we have to be able to finance our health systems, finance our health workforce, finance our supply chain system, and also finance basic equipping of primary health facilities. Our Primary Health Care system is the first point of service. PHC services will not be strengthened by 2030 without adequate fiscal space. To date, majority of African countries are still reliant on external funding sources.

The third challenge is conflict. Yes, we are not in conflict between countries on this continent but we are seeing a lot of conflicts within our countries. For example, poor health outcomes are aggravated in countries like Cameroon, a country with less than 25 million people, and internal conflict. It is nearly impossible to reach people with health services in conflict-ravaged countries. These political instabilities set back gains made in health such as service coverage and quality of care.

PT: What strategies do you think are essential for strengthening healthcare systems in African countries to achieve universal health coverage?

Ngong: Our African government has to take the creation of fiscal space seriously. We cannot constantly rely on external resources as this is not efficient or sustainable. Domestic financing for health has to be extremely intentional, so we have to make sure that we push the agenda on financing health in our various senates and other government decision-making bodies. And as we see climate changes, which will then impact health, it means we will have more demands on the health system. So the first thing is, creating a fiscal space that lessens reliance on external financing.

The second solution is to make sure we bring health closer to the people. We should take advantage of technology – how will we use technology to our advantage, how can we use digital health tools to close the gap in access to health? Are there innovative approaches to health delivery, other service delivery models, promotion of task-shifting, etc.? So I think the solution lies in using technology and innovative service delivery models to bring health closer to our communities.

PT: How can technology be leveraged to improve healthcare infrastructure and services in the context of UHC in Africa?

Ngong: When we talk about technology solutions, people think it’s very theoretical and it can be overwhelming. I would like to give two examples of how technology can enable the delivery of health services.

Amref Health Africa, where I work, uses a mobile health solution called LEAP. Although we used this digital health tool before the COVID-19 pandemic, we saw its utility during the pandemic.

LEAP is used to train community health workers using a mobile training approach. We used this during the pandemic to sensitise community health workers on COVID-19 – how it spreads, key prevention messages, how to prevent it, and how to sensitise their communities. We have reached 3.5 million household members with the much-needed health education, basic first aid, nutrition, and referral services.

Another example, in general, on use of digital health tools – portable diagnostics machines that can detect several diseases using a single device. There are portable devices to measure blood pressure at home, sugar levels at home, home test kits for HIV, and COVID-19, and so on. These are all technology solutions that can be used now.

PT: In what ways can the healthcare workforce be better equipped and expanded to meet the demands of a growing population while ensuring equity?

Ngong: Curriculum development has been mentioned several times during the conference. We must train a fit-for-purpose health workforce, for current health needs and the future. Our training institutions must evolve to meet the demands of now and the future of health. A question that has been on my mind is whether our health training institutions, regardless of cadre, are responsive to the mean age of our population (which is 19 years). That should concern us.

PT: What role do public-private partnerships play in promoting equitable access to healthcare in Africa?

Ngong: Public Private Partnerships (PPP) play a very crucial role and will play a crucial role, particularly over the next 10-15 years as African countries try to build their domestic funding. The reason is that PPPs allow complementarity between public and private funds. Because we do not yet have adequate financing for UHC, we need to have creative funding approaches, for example, PPPs. Private funds or resources can then be leveraged as countries grow domestic resources. So I think PPPs are extremely important.