Universal Health Coverage (UHC) is a path laid with golden promises of good health and equity for all, yet remains one less travelled by African leaders. One disturbing question that keeps me awake is: Why is the Universal Declaration of Health as a Human Right no longer regarded as a sacred oath, one that must be at the heart and soul of our existence? Increasingly, political leaders who promise and strive to serve the people end up becoming their greatest enemy. People assume positions of leadership and turn their backs against the very people whom they are meant to serve, flouting their social contract with the public without any consequences. From a cynical perspective, why would they? After all, they can jet abroad to access quality healthcare when they need to… at the expense of the collective resources of their own people.
This is the viral absurdity in a typical African state, where the more privileged ones live a vastly more healthy and prosperous life than the less privileged ones. For the millions of vulnerable groups and low-income earners who can barely afford to survive or live a pay-check away from poverty- diseases, suffering and death seems to be haste.
While UHC tops the public agenda and is fast becoming a potent vote winner in developed countries, Africa is experiencing the reverse effect. Most times, the term Universal Health Coverage just sounds too elaborate, too exciting and overwhelming a concept to most African leaders and policy makers . UHC is seen as something to make bold commitment to at global events or meetings, only for the aforementioned leaders to get back home and fail to turn their words to action.
The World Health Organisation (WHO) defines UHC as access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access. UHC is a set of objectives rather than a scheme, a direction rather than an endpoint, and an epicenter of the overall health goal. The Sustainable Development Goals (SDGs) were launched with a lot of hope in September 2015. This set of 17 ambitious goals aligned how a better future could be carved out of the current development landscape by the year 2030. Target 3.8 of these goals specifically addressed UHC, stating a need to: "Achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all".
The SDGs are now two years old, which calls into question just how far we have come and how long we still need to go to turn promises into action for UHC, to stop preventable death, and to turn health poverty into economic and shared prosperity.
In a recent WHO 2016 World Health statistics report; sub-Saharan Africa was a source of tragic markers for health: about 22 countries fall within the parameters of those with the lowest life expectancy - far below 60 years of age. That means people born or living in countries such as Lesotho, Chad, Central African Republic, Angola, Sierra Leone, Nigeria, and others are more likely to die earlier than their counterparts living in Switzerland, Iceland, Australia, Sweden, Israel, Singapore, and others. A quick look at the countries with UHC, service coverage and financial protection, shows not only that African countries rank lowest, but why: dismal health indices, poor quality of life, and the disheartening low life expectancy in the continent are not unconnected to this.
Citizens don't have access to quality health services that meet their needs, and out-of-pocket payment constitutes a substantial part of the Total Health Expenditure (THE). Impoverishment or catastrophic health spending characterize their way of life, so they spend the little they earn to survive whenever sickness comes, and some may still not meet these needs even after borrowing to pay the costs of healthcare. This is not supposed to be so, but the bitter truth is that here in Africa, it is happening on a daily basis.
The general tax funded method of financing health is one of the best forms of achieving UHC, followed closely by social health insurance. Disappointingly, even after the Abuja Declaration by African countries to allocate 15% of their budgetary allocation to health annually, only few countries have met this commitment, with most countries largely depending on external funding, and failing to harness local alternative means to raise funds for their health care. Furthermore, while a few countries in the continent have shown promising social health insurance schemes, there still remain many challenges in implementing successful and sustainable prepayment schemes, one of which is the prevalence of corruption and less concern about human lives. In a country like Nigeria, material possessions are given priority over human beings: a car, for instance, is more insured than a human life. The police or Vehicle Inspection Officer (VIO) will stop you to ask for your car insurance and if you don't have any, you are fined, but no one ever cares or enquires whether you have health insurance or not.
We must note the efforts of countries like South Africa, Kenya, Rwanda, and Ghana who have achieved some success in the coverage of their citizens. For those who have a great deal of progress yet to make, reaching UHC may be a long walk but it is not impossible. For once, we have to prioritize policies that promote our ideals of common good, fairness and the sanctity of our existence.
UHC is central to one of those ideals as it focuses on the two core components of coverage of the population with quality, essential health services; and coverage of the population with financial protection, the key to which is reducing dependence on payment for health services out of- pocket (OOP) at the time of use.
Africa must explore sustainable, context-specific financing systems that are designed to effectively provide all people with access to needed health services. Focus should be more on domestic resource mobilization (DRM) thus creating a conducive environment for harnessing private sector finance.
I hope by 2030, when other countries are counting their gains from their commitment to UHC, we, as a continent, won't be counting our losses. I hope we would have been able to change the status quo in which good policies or intentions do not necessarily lead to implementation. I hope Africa will rise to the challenge, and act. I hope there will be sustained political will alongside good technical and leadership capacity, to drive implementation and accountability. Because without this, it will be far easier for a camel to pass through the eye of a needle than for Africans to enjoy and attain good health via UHC.
Meet the author - Alawode Gbadegesin:
Despite coming from a broken home and being raised by a single mother, Gbadegesin started volunteering at the age of 18 and has served a number of notable organizations in Nigeria to create local actions and champion solutions to promote the health of underserved populations.
He is a 2016 Women Deliver Youth Scholar and was awarded the prestigious National Youth Service Corps Honours Award in Katsina State in 2013 and 2014 for his contribution to community development service.
Gbadegesin holds a Bachelor's of Technology in Human Anatomy and a Masters of Public Health, majoring in Health Policy and Management from the University of Ibadan, Nigeria.