KAMPALA - Last week, the world came together to commemorate the Universal Health Coverage Day with a call to governments to ensure good quality health care for their citizens without putting them in economic hardships.
The international theme for the day, which is commemorated on December 12, was “Unite for Universal Health Coverage: Now is the Time for Collective Action”. In Uganda, the day was marked under the theme “Multi-sectoral Collaboration towards Universal Health Coverage, The Role of Parliamentarians”.
Universal health coverage means that people of all ages have access to essential primary health care services, regardless of their status, who they are, where they live, or how much money they have, explains Abenet Leykun Berhanu, the country director for Amref Health Africa (Uganda). Berhanu clarifies that universal health coverage requires that every person should have access to quality health services on the basis of need and not the ability to pay.
He explains that such services should include prevention, diagnosis and treatment of diseases so that people can realise their right to health, which is a fundamental human right. Good health is also necessary to increase people’s productivity, thus leading to economic growth.
Why UHC is important
According to WHO, worldwide, lack of affordable, quality health care has continued to keep many people in poverty and each year, large numbers of households are pushed into poverty because they must pay for health care out of their own pockets.
Globally, every year, about 100 million people are pushed into poverty due to catastrophic out-of-pocket expenditure on health care. In addition, about 30% of households in Africa and Asia have to borrow money or sell their assets to pay for health care.
In Uganda, the situation is not any different, even when the state has signed onto several international protocols aimed at increasing citizens’ access to good quality care and increasing financing to the health sector. Such protocols include the Common African Position on the post-2015 development agenda. Under this, member states committed to provide universal and equitable access to health, in addition to strengthen health systems, including improved health financing.
Universal health coverage is also one of the goals among the Sustainable Development Goals (SGDs) where Goal 3.8 requires countries to achieve universal health coverage, 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.
In addition, Uganda is a signatory to the Abuja Declaration (2001) where African Union countries pledged to commit 15% of their budgets to improving the health sector.
However, in Uganda, there is still limited access to health care and at 41% our out-of-pocket expenditure on health is way too much. This has meant that sometimes, people have to sell their investments to pay for health care, which has kept them in poverty.
In addition, according to information from Amref, Uganda does not have a pooling mechanism, but there is a proposed National Health Insurance Scheme through which this may be addressed. However, the scheme is not yet operationalized; the Bill was drafted and it is yet to go to Parliament for passing.
It is generally believed that universal health coverage (UHC) will prevent catastrophic and impoverishing out-of-pocket expenditures, in addition, to increasing utilization of essential health services, such as maternal and reproductive health services.
Call for a multi-sectoral approach
Amref acknowledges that Uganda is faced with several challenges that hinder the achievement of universal health coverage. These include low per capita income, limited capacity for domestic resource mobilization, lack of political will and lack of comprehensive health policies and plans. Others are weak financial management, poor management systems and weak mechanisms for coordinating partner support.
In a book titled Universal Health Coverage in Uganda: Looking Back and Forward to Speed up the Progress, Prof. Freddie Ssengooba and others note that health is broader than healthcare and thus, it cannot succeed in isolation.
Grace Ssali Kiwanuka, the executive director of the Uganda Health Consumers Organisation, also notes that health is closely linked to different sectors, and urges stakeholders to commit to a multi-sectoral approach to enable us to leverage our limited resources. In this regard, to achieve UHC, there should be a focus on determinants of health such as water, nutrition, poverty education and road safety. Therefore, Kiwanuka explains that we need policy harmonization and for all government ministries to align on policy that would give a unified roadmap to UHC.
“UHC needs the housing ministry to ensure safe affordable housing; water and environment ministry to manage waste and ensure healthy water supply; urban planning to avoid overcrowding and better planning.
These should be supported by roads and works; gender and education to ensure people are empowered with basic information on how to co-exist in health communities and the health ministry ensuring that quality services are available. The agriculture ministry should ensure safe food security,” notes Kiwanuka.
Unfortunately, Kiwanuka adds, right now, everyone is doing good things, but in their own time and at their own pace.
Experts note that changes need to be implemented in the health and social sectors to achieve increased access to health services without leaving anyone behind. In addition to prevention of diseases, Ssengooba and team note that UHC requires resilient health care systems. Therefore, there is need to increase investments in resources such as finances and human resources, in addition to managing technological developments diligently.
Noting that the national budget allocation to the health sector is low at 6.5%, Berhanu explains that there is need to increase domestic resources. Kiwanuka adds that since we have a small tax base, more pressure needs to be applied to draw in the informal sector. There is also need for collaborative effort to increase investment from international players.
Parliamentarians are called upon to fast-track the legislation on the health insurance programme and there is need for more dialogue for the national health insurance scheme to be realized.
Ssengooba also notes that UHC requires strong governance where by critical choices are made transparently and should be informed by evidence, quality should be assured.
People should demand more accountability and citizens are urged to hold leaders accountable to the promise of health for all. The Government needs to be held accountable to honor commitments made.
When it comes to health investments, Berhanu urged the Government to prioritise primary health care services. Such services include family planning, health education and infectious diseases such as malaria and tuberculosis. However, he noted that as African countries are developing, disease patterns have changed. So in addition to the infectious diseases, there is an increase in cases of noncommunicable diseases such as diabetes, chronic kidney disease and cardiovascular diseases. Therefore, there is need to increase community awareness about NCDs and promote lifestyle changes to reduce their incidence.
In addition, Berhanu notes that there is need for home-grown solutions to the problems that have hindered the achievement of universal health coverage in some countries. Such problems include the high population growth and small tax base. In this regard, Amref is organizing the African Health Agenda International Conference (AHAIC) which is aimed at accelerating countries’ progress towards UHC. At the conference, which will be held in Kigali in March, participants are expected to come up with home-grown solutions to address our setbacks and increase access to UHC.