How can we achieve UHC in Africa by 2030?:

Reflections on AHAIC 2019

How can we achieve UHC in Africa by 2030?:

By Ngozi Akwataghibe, Public Health Physician, an Associate of the Royal Tropical Institute, Amsterdam and a Doctoral Researcher in Transdisciplinary Global Health at the Vrije Universiteit Amsterdam

‘Health should not be like playing the lottery – but that is what it has become in Africa. If you’re born rich you win, if you are born poor, you lose.’ This statement was made by Dr Githinji Gitahi, Group CEO of Amref Health Africa at the opening ceremony of the Africa Health Agenda International Conference (AHAIC) which took place in Kigali, Rwanda from the 5th to 7th March 2019. The conference was hosted by Amref Health Africa and the Rwanda Ministry of Health, and I was there with over 1800 delegates from about 49 countries.

What was the focus of the conference?

The conference was focused on Multi-Sectoral Action to achieve Universal Health Coverage (UHC) in Africa by 2030. Dr Gitahi noted that there were still so many dying in Africa from preventable causes and African children were 14 times more likely to die than their counterparts from developed countries. A video message from Dr Tedros Ghebreyesus, the Director General of the World Health Organization (WHO) highlighted the progress the continent has made economically and in increased life expectancy. He told delegates that in view of the planned High level meeting (HLM) on UHC in September 2019, the AHAIC conference represented a ‘key moment for catalyzing support for our global movement.’

Meaningful youth engagement

Considering that the continent has the highest youth population with approximately 70% of people below 35 years, I was particularly pleased to observe that the AHAIC had a strong youth presence. A youth pre-conference took place on the 3-4th March. During the opening ceremony Dr Gitahi, a Youth representative, and Dr Ian Askew – the Director of WHO’s Department of Reproductive Health and Research – had an interesting discussion , on the meaningful involvement of youth in the development of global guidelines and the institutionalization of youth engagement, especially in view of the Social Participation Framework being developed by WHO.

Addressing community-level issues

Community issues was a strong theme in the conference – something I consider very relevant, and not just because I was there with a senior policy maker from Nigeria (Dr Elijah A Ogunsola) for an oral presentation on the formative evaluation of a community based participatory action research project to improve immunization coverage in Ogun state, Nigeria. I was also privileged to be part of a working group in the session on ‘Driving UHC in Asia and Africa through Community led innovation’ where we pushed an agenda for meaningful engagement of communities using evidence-based approaches. Learnings from the plenary included:

  • Technology and data are needed to achieve UHC but most of the technology available are focused on secondary and tertiary sectors and on curative care rather than at community level.

  • There is also need for regulation of new generation actors that are technology-focused.

  • Rich evidence has been generated in both continents (within community health systems) accompanied by numerous innovations – what is now required is cross-regional dialogues and knowledge sharing where countries can learn from each other in order to make efficiency gains by avoiding traditional donor-based silos.

  • The future will rest on regional sharing between countries with similar contexts via multi-stakeholder and multi-sectoral partnerships in order to leverage existing demand-driven innovations and meet health care gaps.

The launch of the 2018 WHO guideline on health policy and system support to optimize community health worker (CHW) programmes was particularly interesting, especially as many governments are yet to be convinced to make financial investments in CHWs. Dr Giorgio Cornetto in his presentation noted that a growing body of evidence supports the effectiveness of using CHW for a range of services, but there was uneven adoption of evidenced-based policies and a lack of replication of best practices. The guidelines – based on 15 systematic reviews with the bulk of the evidence coming from LMICs – take a bold position on remuneration of CHWs, recommending that financial packages commensurate to job demands, complexity, number of hours, training and roles should be provided. It will be interesting to see how that will be operationalized in different African contexts, considering that the orthodox cadre of health workers are usually of the opinion that they themselves are not well remunerated.

A call to action for African governments

As a health policy and systems research expert, I would have liked to hear more about the use of evidence to drive action towards the achievement of UHC in the main plenary sessions, but this was not really the emphasis of the conference. A key focus that reverberated in AHAIC was the call to African governments to tackle the issue of health financing in order to save their populace from avoidable premature deaths and catastrophic out of pocket spending – about 30,000 people enter the poverty bracket every day in Africa due to health costs. It is clear that without increased prioritization of financial investments in health by governments, UHC will not be achieved. Governments were urged to:

  • fulfil their commitments to the Abuja Declaration of at least 15% of annual budgetary spending on health

  • explore innovative financing including innovative tax-based models and public/private sector partnerships

  • to have confidence in relevant, home-grown solutions.

A shift in paradigm was called for – a view of health as an investment rather than an expenditure.

It was encouraging that African government officials – senior civil servants and legislators – were represented in the conference. One hopes to see the various calls to action articulated at AHAIC reflected in the HLM on UHC in New York; African governments attending the HLM; making realistic commitments to UHC; and creating political momentum for strengthening multi-sectoral action towards achieving UHC by 2030.

If you’re interested in finding out more about the AHAIC highlights, you can read the conference round-up for days 1, 2 and 3.

The author thanks 3ie and the Bill and Melinda Gates Foundation for sponsoring her attendance at the conference.

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