Photo Courtesy: Access to Medicines Platform
Universal health coverage (UHC) has been a key aspiration for the global health agenda for many years. Indeed, the world has renewed its commitment to UHC with higher rigor following the Sustainable Development Goals (SDGs) development in 2015.
The World Health Organization (WHO) defines UHC as; "ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation, and palliation) of sufficient quality to be effective, while also ensuring that the use of these services does not expose patients to financial hardship.
Despite this momentum toward achieving UHC, the World Health Organization (WHO) estimates that half of the world's population does not have access to essential health services. In addition, many African countries continue to grapple with high child and maternal mortality levels and communicable and non-communicable diseases. Health systems are also unable to deal effectively with pandemics and epidemics and the growing burden of chronic conditions, such as cancer and diabetes. These challenges require renewed commitments and accelerated progress toward Universal Health Coverage (UHC).
The African Union's 2063 Agenda underpins a call for action for Universal Health Coverage through improved access to quality health services and Health Workforce Development in Africa. Accordingly, the African Union has adopted this agenda (the Africa Health Strategy 2016-2030) to support member states' efforts to achieve universal health coverage and have all Africans access essential healthcare services by 2030.
Many African Countries adopted this agenda and have made strides to improve access to health services through social health insurance schemes, and user fee removal, among others. Despite these significant investments, access to quality health services remains a mirage.
Our collective will as a continent to achieve UHC must also be matched with an understanding of how exactly we aim to make this happen; otherwise, our efforts become fruitless. In 2013, for example, Kenya abolished user fees in public healthcare facilities to increase utilization rates, especially for maternal and newborn care. While this strategy successfully increased utilization, maternal and newborn mortality rates remained largely unchanged. Several scholars have demonstrated the reasons for this malady as being the fact that increased access to services did not come with a commensurate increase in human resources, medical supplies, and infrastructure. Furthermore, the loss of revenue by the health facilities coupled with erratic exchequer reimbursements led to worsening quality. This example underpins the fact that Quality improvement and UHC are not mutually exclusive; one cannot be achieved without the other.
If countries do not prioritize quality improvement now, it will be too late when they embark on this journey toward UHC later on down the road. Therefore, there needs to be a clear understanding between policymakers and practitioners on what constitutes good quality care before any structural changes can take place within hospitals or other institutions where patients receive care.
The first step in institutionalizing quality involves defining the problem for which we wish to improve health outcomes - in other words, what's wrong with our current health system? Once this is established, each stakeholder group involved with UHC must understand their role and responsibilities toward achieving success. Without clear goals, strategies, and measurements, even high-level commitments like those made in the Abuja Declaration and SDGs will remain just that–commitments.
High-quality care can be also be achieved through several key areas, including innovation around new models for care delivery based on evidence-based practices and mobilization of resources through increased public funding for health services, public-private partnerships, private capital providers, and philanthropic organizations. This resource mobilization should be largely homegrown, by Africans, for Africans.
In addition, there is growing evidence to suggest that quality healthcare can be attained through public reporting, technology, clinical decision support, workforce training, accreditation, health literacy, and targeted incentives for providers to improve their quality of care. These efforts should also include investing in the infrastructure needed for hospitals to deliver more efficient patient care.
At the core of these efforts must be the development of strong leadership within African countries' ministries of health and the African Union.
Health systems will be judged by the quality of care they provide, not by how much they spend or how quickly they expand essential care. As we move towards a more sustainable future, it is important to remember that we cannot let short-term gains drive our progress at the expense of long-term sustainability. If we want to achieve UHC and institutionalize quality improvement in healthcare delivery, we need a clear vision and strategy for how this goal should be attained. This will require systematic improvements and significant collaboration and contributions from all global leaders, champions, and actors involved in shaping health systems across Africa and beyond.
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