African countries urged to fast-track universal health coverage

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ENTEBBE - Member countries of the Partner in Population Development in Africa regional office (PPD ARO) have been urged to prioritise universal health coverage.

“Together, we must continue to advocate for greater access for the poorest segments of our society to basic education, economic opportunities for the young people, health services, including reproductive health/ family planning care services without any financial burdens,” planning state minister  Amos Lugolobi says.

In his speech read by Dr Jotham Musinguzi, who is the presidential advisor on population and development issues, Lugolobi says there is a need to play an advocacy role for women’s and girls’ health and to break the devastating cycle of poor health, illiteracy, high fertility and poverty that are still prevalent in the majority of our countries.

According to him, these are very important agreements and initiatives that remain valid and relevant and should not be relegated to the shelves. They are excellent blueprints which contribute to the well-being of society if effectively implemented.

He was speaking during the partner country coordinators from the Partner in Population Development in Africa regional office meeting at Imperial Gold View Hotel in Entebbe on Wednesday, August 21, 2024.

The two-day meeting pulled delegates from 13 countries out of the 17 that constitute the membership of Partners in Population Development (PPD).

The representative of the board chair Partners in Population Development (PPD), Mahlatsi Koma urged the delegates to bring to the limelight the issue of leadership and political will to address health, population and development challenges.

“We should see ministers of health, finance & economic development, population, social welfare as well as Members of Parliament (MPs), especially those who sit on Health and Social Service Committees of Parliament are engaged to enlist their commitment to health and development at country level,” Koma said.

He said the delegates should find ways of how best to engage political leaders and make them accountable to the commitments they make to addressing national and international protocols on health, for example, universal health coverage, the International Conference on Population and Development, (ICPD) the sustainable development goals (SDGs), the Africa leadership meeting commitments, the Abuja Declaration, among others.

Universal health coverage (UHC) aims to ensure that all people have access to the full range of quality health services they need, when and where they need them. UHC and sustainable development goals (SDGs) agendas were ratified by our countries in December 2012 and September 2015 respectively.

Health coverage policy

Uganda already has a universal health coverage policy, and significant progress has been made in achieving improved reproductive health, maternal and child health care services, provision of reproductive health commodities and access to family planning services, the director family health at the National Population Council Dr Betty Kyadondo said.

The maternal death rate declined by 44% from 336 deaths per 100,000 in 2016 to 189 deaths per 100,000 in 2022, surpassing the target of 261 deaths that was set by the government for the year 2023. This is also in tandem with achieving the SDG target of 140 deaths by 2030. 

The newborn death rate decreased by 22% from 27 in 2016 to 22 deaths per 1,000 live births in 2022 which is close to the 2023 target of 21 deaths per 1,000 live births.

Between 2016 and 2022, the proportion of births attended by skilled health personnel increased from 74 per cent to 91 per cent. Infant mortality rate reduced from 43 per cent in 2016 to 36 per cent in 2022 and under-five mortality reduced from 64 per cent to 52 per cent within the same period. 

Modern contraceptive prevalence rate increased from 39 percent in 2016 to 43 per cent in 2022 and the unmet need for family planning reduced from 28 per cent in 2016 to 22 per cent in 2022. 

Life expectancy increased from 61.4 in 2016 and is currently estimated to be 64.7 in 2024.

Kyadondo attributed the indicators to a lot of collaboration between government, development partners, civil society organization, faith-based organizations, cultural leaders and the private sector.

Insights from other countries

The senior technical advisor Ministry of Health & Social Action Senegal Dr Cheikh Tidiane Gueye said attaining UHC requires a combination of different health financing and governance mechanisms to improve the availability of services, reduce out-of-pocket payments and extend health risk coverage to a wider population, taking particular account of vulnerable populations, for reasons of equity.

Dr Jotham Musinguzi, the presidential advisor on population and development issues remarks. (Credit: Agnes Kyotalengerire)

The assistant director of population policy, programme and partnership at National Council for Population and Development, Irene Muhunzu, said Kenya launched the UHC pilot programme in 2018, covering four counties, with the goal of expanding nationwide.

This pilot provided valuable lessons and increased access to healthcare services. In 2022 UHC was scaled up to all the counties.

Some of the interventions for attainment of UHC and SDGs in Kenya include a social health insurance Fund with the aim to provide coverage for all Kenyans under a social health insurance scheme, ensuring that no one is left behind in accessing essential healthcare services. 

Reforms are being undertaken at the Kenya Medical Supplies Authority (KEMSA) to ensure that it meets the commodity supply needs of counties efficiently and effectively, reducing bottlenecks and ensuring timely delivery of essential medical supplies, Muhunzu noted.

Kenyan also initiated a Kshs 3 billion program to provide stipends to Community Health Promoters (CHPs), recognizing their critical role in delivering primary healthcare services at the community level, thus strengthening the foundation of UHC.

Others include the universal health coverage curriculum which aims at developing and implementing a curriculum focused on UHC, designed to educate healthcare professionals and stakeholders on the principles and practices necessary to achieve comprehensive healthcare coverage for all Kenyans.

In the bid to achieve universal health coverage, Gambia has prioritized investments in maternal and child health, expanded access to health care services including reproductive health care services, and family planning services, and is providing comprehensive sexuality education, among other initiatives notes Binta Chama a delegate.

The country has also developed a Health Financing Strategy for 2019-2024 and a National Health Policy for 2021-2030. These initiatives in collaboration with WHO and other UN partners, guide the implementation of reforms aimed at achieving UHC.

The National Health Insurance Act 2021 was enacted to ensure the attainment of UHC in Gambia.

In August 2022, the National Health Insurance Scheme (NHIS) was launched to ensure access to quality healthcare services for the most vulnerable groups, including children, women, and the elderly, Binta said.

The Kabilo Baama Initiative and male action groups still continues operating. It is a community-based intervention designed to increase the uptake of reproductive health services and empower women and girls.

Male clinics were established to encourage male participation in reproductive health issues and support women during pregnancy and delivery. Major facilities were provided with life-saving drugs, and over USD 1 million worth of medical equipment and supplies were delivered to strengthen maternal health services.

Gambia is also conducting advocacy and communication campaigns for family planning including sensitizing women and girls in hard-to-reach areas about contraceptive methods and engaging community structures, traditional and religious leaders about Sexual Reproductive Health and Rights and Sexual Gender Based Violence issues for example female genital mutilation ( FGM, Child marriage, teenage pregnancy.

 The deputy director of technical cooperation, PCC for Tunisia, Lejri Nabila, said to achieve universal health coverage (UHC), Tunisia has focused on several key interventions.

These include health financing reforms to ensure sustainable and equitable financing mechanisms, such as increasing government health expenditure and reducing out-of-pocket payments for patients.

Lejri from the National Board of Family and Population, Ministry of Health, Tunisia, added that they are ensuring service delivery improvement to enhance the quality and accessibility of health services, particularly in underserved areas. 

This includes upgrading health infrastructure, improving supply chain management for essential medicines, promoting inclusive programs and ensuring a sufficient and well-trained health workforce.

Strengthening of health information systems has been done to improve data collection, monitoring, and evaluation. This supports evidence-based decision-making and better resource allocation, Lejri said.

Others include strengthening primary health care by expanding coverage, integrating services, and focusing on preventive and promoting health care. 

This involves investing in community health workers and developing primary health care facilities.

Health insurance expansion in order to expand health insurance coverage to ensure that more citizens have access to necessary health services without financial hardship. 

This includes scaling up existing social health insurance schemes and exploring new models for coverage.

Encouraging collaboration between the public and private sectors to leverage resources, expertise, and innovations that can improve health service delivery.

Health education and awareness to raise public awareness about health issues and promote healthy behaviour through education campaigns and community engagement initiatives.

International co-operation and support to leverage international partnerships and support, such as South-South cooperation, to share best practices, access technical assistance, and mobilize additional resources for health are the other interventions.