Part 1: Universal Health Coverage - One Size Does Not Fit All
The journey toward UHC is incredibly complex and important. The COVID-19 pandemic has highlighted the already-existing gaps in the health sector, reinforcing how essential it is to establish well-functioning health systems. UHC affects and is affected by every aspect of the health sector and beyond. It will ultimately only be achieved with interventions on the national,regional and continental levels. While integration and cooperation across national and regional barriers is necessary, ultimately, each country will require its own unique set of innovative solutions. We need guidance and helpful frameworks from the African Union level, integration and collaboration at the regional level, and wise leadership and effective strategy at the national level.
UHC at the National Level
According to the World Health Organization (WHO), universal health coverage (UHC) is achieved when “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.” Governments across the world are embarking on this UHC journey and no two journeys will look exactly the same. It is important, therefore, to think of how UHC should be implemented on a national, regional and continental level. Although regional and continental bodies have a significant role to play in achieving UHC, the vast majority of the workload will inevitably fall on the shoulders of those at the national level. The African continent is incredibly diverse and achieving UHC will require country-specific approaches and implementation strategies.
Each African nation has its own unique history, political systems, cultures and languages, so there is no reason to think that healthcare would be an exception. From Ghana (which is the only country in the world to use revenue from value added tax to help fund their journey toward universal health coverage) to Namibia (which still struggles with the heavy burden of the HIV/AIDS epidemic) to Uganda (which has made steps toward universal health coverage, but has a significant way to go), each region and country has its own set of advantages and challenges.
African nations must look carefully at their own economic situation, create strategies that provide the most cost-effective solutions and look for potential sources of funding. It is also up to each country to decide the timing of their journey toward UHC. Depending on competing priorities, such as political or economic instability or security threats, UHC may need to be on a slower timeline than some might hope. Countries like Libya or Somalia, for example, cannot expect to prioritise UHC when more fundamental challenges need to be solved first. Countries will also need to decide how to structure their UHC design. This is an essential but incredibly challenging task because of the complex and far-reaching nature of its implementation.
Successfully achieving UHC will touch every aspect of healthcare and beyond, including ministries of finance, infrastructure development and education.
Ghana is often cited as the most prominent and successful example of UHC in Africa. The country has started their journey towards achieving UHC using income from VAT to fund their efforts. While they have achieved a national buy-in and consensus on the importance of UHC, they have still struggled when it comes to deciding on the details of implementation. A roadmap established in July of 2019 has the potential to result in further progress. Other countries can and should look to the example of Ghana (or even beyond the African continent to places like Japan, for example) as a reference, but any attempts to replicate or imitate without adaptation to each country’s unique context will only result in solutions that don’t effectively address the actual challenges.
This article is the first of a three-part series. The two follow-up articles will be published in the next weeks and will address the regional and continental roles of achieving UHC.