Africa: Three Promising Pathways to Universal Health Coverage in Africa

Mother and healthy baby in a family planning clinic in the Oromiyaa region of Ethiopia.

Growing up, I made an observation that would end up shaping my career: the quality of a country's primary health care system is a litmus test for the health of a nation.

In my home country of Rwanda, I saw firsthand the consequences of a massive health worker shortage and a system that crumbled in the wake of a devastating genocide. Yet in the following decades, Rwanda showed what is possible when a country prioritizes its people. Thanks to investments in health, maternal and newborn mortality rates plummeted and life expectancy increased by more than 20 years.

We are now at a critical moment in Africa's health care journey. From Botswana to Kenya to South Africa, countries across the continent are considering or enacting unprecedented health reforms. The coming months and years are a crucial window to see if countries can make good on their promises, beginning at tomorrow's Africa Health Agenda International Conference in Kigali.

The conversations in Kigali will be key to uniting the African community ahead of the first-ever United Nations High-Level Meeting on Universal Health Coverage in September, when Heads of State from around the world will gather in New York to chart a course toward achieving universal health coverage.

As someone who has spent my life working to improve health systems, I am often asked what reforms countries should prioritize. The answer is clear: there is no better return on investment than strengthening primary health care, the backbone of all great health systems. But how do we do that?

While every country's path to universal health coverage will look different, I am excited about three key approaches: using data to guide improvements, leveraging new technologies to expand access to care, and making better decisions about where to spend resources.

Harnessing data

As the saying goes: if you can't measure it, you can't manage it. Reliable data on primary health care is essential to help policymakers identify gaps and make targeted investments. Yet for years, many countries have lacked this information.

Thankfully, tools like the Primary Health Care Performance Initiative's Vital Signs Profiles are providing new insights on crucial dimensions of primary health care like financing, capacity, performance and equity. A set of Trailblazer countries, from Rwanda to Senegal, are already using this tool to identify priorities for investment.

Without a real-time diagnostic of what ails a nation's health system, millions of Africans will continue to go without care. Health leaders around Africa must consistently collect these types of data and use evidence to guide improvements.

Using technology to reach more people

Technological breakthroughs mean that we have an opportunity to care for more people.

One promising example is Babyl, a service that connects individuals to primary care providers via mobile phones. Introduced in Rwanda two years ago, Babyl has already registered more than 2 million users.

Thanks to Babyl, Rwandans across the country can seek the counsel of health professionals without traveling to a facility or waiting in long lines. After the initial phone consultation, Babyl can also connect people to facilities, pharmacies and labs if needed. Though still a pilot program, these early successes highlight how countries can utilize technology to reduce barriers to care.

 Getting more value for money

To achieve universal health coverage, we need to make better decisions about where to spend our money. Which populations should be targeted, with what services, and from which providers? When these decisions are made deliberately, they lead to better health for more people.

Take Ghana's innovative 'gatekeeper' program. When Ghana's national health insurance system launched, patients would often seek basic consultations and treatments at expensive hospitals. The government recognized that this strained the health budget and amended the policy: now, patients must first visit a primary care provider, who serves as the gatekeeper to the rest of the health system. This cuts down on unnecessary hospital visits and helps the system run more efficiently.

Institutions like the Strategic Purchasing Africa Resource Center (SPARC ) can help policymakers and health system managers make these decisions. Launching this month, SPARC is a platform to build leaders' capacities and share learning experiences, so that countries can redesign health systems to get more value for money.

The Road Ahead

As countries across the continent increasingly commit to Health for All, the next step is identifying the reforms that will help get there. Improving primary health care systems through better data, technology and strategic purchasing is the smartest way forward.

We all have a role to play in translating rhetoric into results and transforming health on the continent. Let's get to work.

Jean Kagubare is the Deputy Director of Global Primary Health Care at the Bill & Melinda Gates Foundation.

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