Challenges of Universal Health Coverage will be great, but not insurmountable
The topic of Universal Health Coverage (UHC) is a weighty one, even more so in the African context, given the challenges and opportunities that arise in implementing it.
The high personal cost to citizens, who must pay excessive fees for quality health-care services, is well known, and the point of UHC is to prevent financial hardship. It is a worthy and noble goal, which we need to strive for.
There is a significant body of research into this subject, and there are many learned colleagues, including academics, health care workers and public servants, who are grappling with this matter in depth.
My remarks, which reflect on some key learnings in the global context, will hopefully contribute to taking the agenda forward on the implementation of UHC in Africa. I spent 10 years in medical practice and the issues of access and affordability to good quality health care for citizens, occupied me then on a daily basis as a medical doctor.
When I began practising in the 1980s, the times were indeed dark in apartheid South Africa and access to quality and affordable health care was difficult, to put it mildly, for the majority.
South Africa has made much progress since then. Nelson Mandela, our first democratically elected president, first introduced free prenatal and antenatal health care for women and children up to the age of six in the public health-care system in 1996. This was one of his flagship projects and in doing so he demonstrated his vision and understanding of the importance of accessible health care as one of the key pillars in building the nation, social cohesion and a productive and democratic society.
We continue to be inspired by the legacy he bequeathed us. Sustainable Development Goal (SDG) 3 calls for the ensuring of healthy lives and well-being for all by 2030. Point 3.8 specifically calls for the achieving of “universal health coverage (UHC), including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality and affordable essential vaccines for all”.
All member states of the UN have in principle agreed to the implementation of UHC by 2030, in line with the SDGs. However, according to the World Health Organisation (as at December 31 last year), approximately half the world’s population still do not have access to essential health services, about 100 million are driven to live in extreme poverty due to having to pay for health care, and more than 800 million people spend a minimum of 10% of their budget on health care.
These statistics indicate quite clearly that the road to its implementation will be a challenging one. Therefore, it is encouraging that the prioritisation of this SDG was referenced by world leaders at the G20 Summit in 2017, and will remain high on the agenda for both governments and civil society until 2030, when this milestone is expected to be achieved.
In the context of Africa, the AU – Agenda 2063 lists as one of its aspirations to have a continent free “from fear, disease and want”, and that by 2063 the people of Africa should have “sound health and well-being”.
While timelines differ between the SDGs and the Africa 2063 agenda, the aspiration to achieve optimum health and well-being for citizens is a clearly stated objective of both. Of course, the research demonstrates that where health care needs of citizens are satisfactorily met, it facilitates higher economic participation and productivity.
Those of us who run corporations or institutions are all too aware of the high cost of absenteeism due to ill health of employees and the challenges that this presents. More countries are actively pursuing UHC, and undoubtedly the support provided by the SDGs, Agenda 2063 and the drive by world leaders, adds impetus to this pursuit.
There are numerous examples of the implementation of UHC in the world and, for the most part, none of them use the same model. Undoubtedly, the issue of approaching UHC could be served by framing a set of principles to guide countries that are still to embark on or are still completing this journey.
Even for those who have already implemented UHC, a constant process of review to measure stated objectives, is advisable. This collaborative approach is important given the many challenges that confront developing countries, and, in the context of our discussion today, countries in Africa.
These challenges include funding, health epidemics, ratio of health care providers to the population, ever-increasing need, the impact of war and conflict, and the impact of the world economic climate.
Given all these challenges, the objective of achieving UHC will not be easy, but is not insurmountable. To conclude with a quote from the venerable Mandela: “After climbing a great hill, one only finds that there are many more hills to climb.”
Dr Iqbal Survé is the executive chairman of the Sekunjalo Group.