Universal Health Coverage in Africa: Where is Civil Society?

Universal Health Coverage in Africa: Where is Civil Society?

{Photo credit: Todd Shapera.}Photo credit: Todd Shapera.

This post originally appeared on The Lancet Global Health Blog.

A strong civil society is essential for realizing the lofty goal of achieving universal health coverage (UHC). While the ongoing global discussions around UHC have largely focused on the role of government and development partners in designing and implementing risk pooling mechanisms that have the potential to improve access to essential health services, there has been little discussion on the key role that local civil society organizations (CSOs) play to ensure various communities support UHC and hold governments accountable.

Key global, regional and national stakeholders have endorsed UHC over the past three years. The UN General Assembly, World Bank Group, and the World Health Organization (WHO) are among leading advocates for UHC as a plausible post-2015 goal, and a platform for sustainable development and poverty eradication by 2030. Major high-level declarations such as the Bangkok Statement, the Kigali Ministerial Statement, the Mexico City Political Declaration, Tunis Declaration, and the Recife Declaration reinforce the value of the concept.

Other international conferences underscore the vital role of UHC in sustainable development. The UN Conference on Sustainable Development (Rio+20) recognized that UHC has the potential to increase economic growth, improve educational opportunities, reduce impoverishment and inequalities, and foster social cohesion. The 66th World Health Assembly held in May 2013 asserted that UHC is critical to health system strengthening in many countries and can ultimately improve health outcomes. It proposes that member nations “modify their health financing systems in the search for universal health coverage."

Despite available declarations, most African countries are yet to demonstrate needed commitment towards UHC in policy design and implementation. Access to health care in the region is still predominately paid out of pocket, which prevents millions of people from accessing much needed health-care services, and results in many preventable deaths. The rhetoric on UHC should immediately be translated in to well-designed policy that ensures everyone has access to the health-care they need without suffering catastrophic financial hardship.

Several communities of practice have been formed in the region to support practitioners and policymakers that are implementing reforms, including the Health and Harmonization in Africa Financial Access for Health Community of Practice, and the Joint Learning Network for Universal Health Coverage (JLN), a practitioner-to-practitioner network led by representatives from nine countries in Africa and Asia. The JLN is unique in that it connects practitioners from around the globe–both virtually and in-person–to focus on the practical “how to” of implementing reforms.

While the JLN and other global efforts are important and complementary to advocacy and technical assistance activities, civil society actors–specifically in Africa–must add their voices to the national debates to ensure that UHC is rooted in the right to health, and that their governments are obligated to provide all citizens universal access to quality essential health services with financial protection. They must hold global stakeholders and national governments accountable on UHC-related commitments working in collaboration with practitioners.

The voice of civil society has been faint but growing.

At the African Heads of States and Government Special Summit on HIV/AIDS, TB and Malaria in July 2013, African civil society organizations (CSOs) called for increased funding for health, accountability in health spending, and UHC, and urged governments to support the inclusion of UHC as the overarching framework for the health-focused post-2015 development goals.

In Ghana, the Universal Healthcare Coverage Campaign mobilizes multiple stakeholders through public events, media engagement, and lobbying to advocate for UHC. The campaign raises awareness about health insurance schemes and alternative tax-based and innovative health-care financing mechanisms to deliver universal health care. 

In Ethiopia, Nigeria, and Kenya the Health for All: The Campaign for Universal Health Coverage in Africa, funded by the Rockefeller Foundation and led by Management Sciences for Health (MSH), supports existing government initiatives towards achieving UHC in collaboration with other regional and local partners. The campaign works closely with key stakeholders such as government agencies, law makers, development partners, associations of health workers, media houses, celebrities, students, and non-governmental organizations (NGOs) to raise awareness about risk-pooling pre-payment mechanisms that will improve access to health care for the populace, particularly women and children. It uses large-scale media campaigns, press conferences, town hall meetings, and other avenues to garner political and social support for health system reform that can facilitate UHC. In Ethiopia, the Health for All campaign works closely with the Ethiopian Health Insurance Authority to popularize national health insurance. As a member of the Health Financing Technical Working Group of Kenya’s Ministry of Health, the campaign will support the government to design a communications strategy when the UHC Strategy document is finalized. In Nigeria, the campaign is a key member of the Technical Working Group for a proposed Presidential Summit on UHC being planned by Federal Ministry of Health and National Health Insurance Scheme. The Summit is expected to achieve high-level endorsement for a comprehensive costed roadmap for UHC in Nigeria. It also mobilizes grassroot support for health insurance.

Although these efforts are laudable, the voice of local UHC advocates must be louder on the continent to mount the needed pressure on governments to design and implement UHC-focused policies that build on the success of the health-related Millennium Development Goals. We need to mobilise political and social support for UHC at all levels as well as rally existing hesitant CSOs to join the emerging global movement for UHC.  

Until civil society rises to this challenge, many families in poor rural communities in sub-Saharan Africa may continue to suffer financial hardship because of catastrophic costs of health care.

Nkem Wellington (Results for Development Institute and UHC Forward) and Jonathan Jay, Dorah Nesoba, and Barbara Ayotte of MSH contributed to this content.