Achieving universal health coverage in Africa: What needs to be done

Monday September 9 2019

Micheal Mugisha

Micheal Mugisha 

By Micheal Mugisha

Universal health coverage (UHC) is defined 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 the user to the financial hardship.
Universal health coverage has, therefore, become a major goal for health reform in many countries and a priority objective of the World Health Organisation.
However, achieving universal health coverage requires large sums of money but estimates show that the 67 low-income and middle-incomes countries represent 95 per cent of the population in these countries but the annual financing gap to reach Sustainable Development Goals on UHC is more than $370 billion.
It is important to note that about half of these countries are in Sub-Saharan Africa where the health financing gap is acute yet Africa makes up 17 per cent of the world population but carriers 23 per cent of the global disease burden.
In 2015, Africa accounted for about 1 per cent of the total global health expenditures, in per capita terms this implies that the rest of the World spends 10 times more on health care than Africa.
Note that in 2016, 44 per cent of the current health expenditures in Africa were financed through domestic government funds.
However, more than 37 per cent of all Africa’s health spending comes from out-of-pocket payment. Such a burden has significant implications for households.
Statistics show that 11 per cent of Africans experience catastrophic spending in accessing health care annually whereas more than 38 per cent delay or forgo healthcare due to high costs.
Furthermore, increased donor funding to the health sector (in Uganda, the health sector budget is about 50 per cent donor funded) is still not sufficient enough to improve financing need to attain universal health coverage because external support for health is a tiny share of global health spending just at 9 per cent for Africa.
The Addis Ababa Action Agenda of 2015 emphasised the need to strengthen domestic revenue collection and resource allocation efforts as strategies to attaining UHC but it is not clear how many African countries are actually doing this.
Nevertheless, strengthening revenue collection efforts and improving allocation of existing public resources to achieve universal health coverage can be done through strengthening tax capacity to allow for “fair space” for financing health and social sectors, even at a constant budget share.
Secondly, as national income and domestic revenues increase, the allocation of public funds to health should be better prioritised within existing annual fiscal frameworks.
Thirdly, strengthening high-level leadership to encourage greater engagement between health and finance authorities in determining the level and allocation of health public budgets.
Beyond budget prioritisation, improving predictability in both domestic and external resources as a key to allowing effective planning and implementation of sector activities should also be considered.
Prioritising and strengthening better documentation in the use and benefits of public funds committed to health across socio-economic groups to ensure that all levels of health financing systems are more accountable and transparent such that “no one is left behind” is not just a slogan.
Defining packages of essential services to be purchased in alignment with adequately designed service provider incentives which could help direct public financing into more effective delivery of priority health services to priority populations.
Eventually, achieving universal health coverage in Africa will depend on strengthening revenue collection efforts and improving allocation of existing public resources.