This year’s theme for International Universal Health Coverage (UHC) Day is “Keep the Promise”. We sat down with Dr Githinji Gitahi, CEO of Amref Health Africa and co-chair of the UHC2030 Steering Committee to discuss how to operationalise and finance UHC after the various global commitments and plans to achieve UHC that took place this year.  

World Leaders have repeatedly said that health is the wisest investment a country can make. Given the current low health financing levels across the African continent, what steps do you think leaders need to take in order to achieve UHC?

With the 2019 Global Monitoring Report we now know how far we can get if we mobilise resources to invest in the right places. Whereas it was clear that access to health services has grown, its done so at the cost of rising houseld expenditures. There is therefore a clear mandate to increase public revenues for governments to invest in health to avoid 5 billion people missing out on healthcare by 2030 [1]. Investing an additional 1% of a country’s GDP for primary health care (PHC) per year until 2030, could save close to 100 million USD and increase life expectancy by 3.7 years [2]. So, the potential gains of investing in health are enormous.

Broadly speaking, all countries need to raise domestic resources to increase spending on health and reorient financing mechanisms towards PHC. This will require the push for more meaningful partnerships, empowering local healthcare providers and leveraging digital solutions to deliver UHC in a more aligned and cost-efficient way [3].

We know that for the poorest countries, certain reforms may not be sufficient or even feasible. This means that to bring these reforms to action, policy decisions need to be guided by evidence of what works and does not based on the different fiscal realities of each place.

Their economies are small and highly informal. Finally, in view of the limited resources in these settings choices on what to buy and for whom will need to be made by countries within their available fiscal space using an equity lens.

International solidarity remains a priority in these settings.

Primary health care is an essential pillar for UHC, but many countries in sub-Saharan Africa face a huge shortage of health workers with an average of only 1.1 health workers per 1,000 population. How can this shortfall in human resources that hinders the attainment of UHC in many countries be addressed?

The 2019 Global Monitoring Report documents the improvements in expanding access to essential health services that all regions and income groups have achieved in the past couple of years, with poorest countries making the greatest gains [4]. This is to be celebrated and used as an example of the need to invest in strong PHC.

As you rightfully say, health care workers are central to the delivery of high-quality services. Having more health workers will improve coverage and quality of care. To be effective, health care providers need to be present in adequate numbers, and they need to be competent, supported and well-resourced.

We need bold and innovative approaches to training and retaining health care workers. An essential pillar is that doctors, midwifes and community health workers alike are properly remunerated and enjoy decent work and living conditions. We also need to equip them with tools that will enable them to use resources more efficiently such as digital technologies. Of course, we need to ensure that these technologies are bringing in accessible and readily adoptable solutions, rather than an additional burden in the already constrained healthcare workers. Needless to mention, we also need to ensure we implement these solutions with an “equity” lens, to avoid the most vulnerable not being able to benefit from these innovations.

Good leadership and good governance are also necessary for achieving UHC – Any suggestions how countries can reduce inefficiencies in health care?

Leaders in the African Union have committed to deliver on UHC [5]. Politicians around the world have also committed to take all legal and policy measures to achieve UHC [6]. These are already great examples of good leadership and good governance.

I think we need to minimise waste resulting through mismanagement of supplies and reduce inefficiencies at both country level and at global levels. In its 6 Key Asks, the UHC2030 movement asked for countries to ‘Spend More and Spend better’. I am proud to say that UHC 2030 has been an instrumental platform to align on complementarity and concrete synergies at both levels between the 12 agencies that signed into the Global Action Plan for Healthy Lives and Well Being for All (GAP) [7]. This recently launched plan agreed between 12 multilateral agencies has a strong focus in coordinating concrete SDG3 related actions from countries, to countries and by countries. And that’s a great improvement on good leadership and good governance practices at both levels. The GAP will be pivotal in increasing cooperation and avoid duplication of efforts.

How do you think the Political Declaration on UHC can be translated into concrete benefits for societies across the world? Is partnership the model for delivering UHC?

The Political Declaration of UHC was a commitment that governments made with their people and their constituencies. In UHC2030 Key Asks, Universal Health Coverage is captured as a Social Contract asking for Political Leadership Beyond Health. The foundation has been laid and now they must mobilise to act and deliver their promise for accessible quality health care or all without the risk of financial hardship.

People should hold their governments accountable for this promise. That’s why, three months after the adoption of the Declaration, this year’s theme for International UHC Day to “Keep the Promise” could fit any better. I am also a strong believer that civil society is a broker of trust [8]. This means that civil society organisations working across health areas have an important role to take in brokering the actions that enable societies and communities to hold government responsible for their promises.

Which role do you see the private sector having in moving towards UHC by 2030?

UHC 2030 believes that the private sector is a key player to achieve UHC, particularly in the area of health service delivery. That is why, we are looking to work with private sector entities that can provide goods and services across the health value chain -regardless if they are service providers, health insurers, or manufacturers and distributors.

The UHC 2030 Global Multi-Stakeholder Dialogue on Private Sector Engagement for UHC seeks to explore and foster new partnerships toward UHC outcomes, including opportunities of return on investment with public policy objectives of equitable access to quality essential health services and financial protection. We think that by facilitating these multi-stakeholder dialogues we will enable governments to take a demand-driven approach to private sector engagement focused on PHC. We hope that this way, governments will be ultimately better equipped to make decisions about the role of private sector in their own countries based on their specific needs. And that’s a great step forward.

[1] https://www.un.org/press/en/2019/ga12181.doc.htm

[2] https://www.who.int/docs/default-source/documents/2019-uhc-report.pdf

[3] https://www.devex.com/news/opinion-how-to-achieve-uhc-invest-more-and-better-95451

[4] https://www.who.int/docs/default-source/documents/2019-uhc-report.pdf

[5] https://cs4me.org/news/african-leaders-new-committement-for-universal-health-coverage-uhc/

[6] https://www.ipu.org/news/press-releases/2019-10/ipu141-assembly-adopts-first-parliamentary-resolution-achieve-health-coverage-all-2030

[7] https://www.who.int/publications-detail/stronger-collaboration-better-health-global-action-plan-for-healthy-lives-and-well-being-for-all

[8] https://www.youtube.com/watch?v=yX0ez2XoZmQ

Author

• Githinji Gitahi