Joining the dots on universal health coverage

Emma Mulhern, April 2019
A panel of six people sit on a stage in front of an auditorium half full of guests.

As the second World Health Organization Africa Health Forum comes to an end in Cabo Verde, I can’t help but wonder how the dialogue will feed into the forthcoming UN High Level Meeting on Universal Health Coverage (HLM-UHC). 

The HLM will bring member states and different stakeholders together ahead of the UN General Assembly in September to generate a political declaration on UHC. But the HLM did not feature at last week’s forum – which focused on achieving UHC and health security – at all.

Is this a missed opportunity? Will the official communiqué be shared with the co-facilitators of the HLM? Who is joining the dots?

Over the course of the last three days, two recurring themes emerged that I hope will feature in the political declaration that comes out of the HLM in September.

Primary healthcare is the foundation for UHC – but the health system underpinning it needs to be strengthened.

There was recognition in many sessions that investing in and expanding primary healthcare is key to accelerating progress towards UHC. However, it was consistently flagged that inherent weaknesses in health systems in many African countries hinder progress and need to be addressed urgently.

Limited human resources for health in particular was noted as a critical issue facing countries. Problems in this area ranged from challenges in terms of absolute numbers and distribution of available health care providers, to fiscal challenges in training and retaining health care providers.

UHC will only be achieved through domestic resource allocation.

UHC requires sustainable and predictable finance from domestic sources. It was acknowledged at the forum that governments will only realise UHC through progressively increasing allocation of domestic funding to health. This needs to be coupled with an examination of how existing resources are utilised, efficiencies and priorities identified, and potential financial reforms considered. In their addresses to the event, ministers of health from Cabo Verde and the Seychelles put the spotlight on finance as key to the progress their respective countries have made towards providing UHC to their citizens.

The challenges of achieving effective financing were openly recognised, but many panellists spoke about the need to frame health in a way that will get the attention of parliamentarians, Heads of State and Ministers of Finance. WHO estimates that nearly 630 million years of healthy life were lost in 2015 due to the diseases afflicting the population across 47 member states in Africa: a loss of more than US$2.4 trillion from the region’s gross domestic product value annually. Investment in health needs to be grounded in the economic benefits, as well as the traditional human rights approach to health.

We need action on leaving no one behind.

Last week, the commitment of the 2030 Agenda for Sustainable Development to ‘leave no one behind’ was emphasised on occasion by civil society, young people and the Prime Minister of Cabo Verde during his closing remarks. Unfortunately, it did not feature more prominently. It is critical that there is a focus on leaving no one behind in the political declaration this September.

We know that equity is a key dimension of UHC. The political declaration from the HLM needs to specifically recognise those people who are not being reached by essential services, who face barriers to access, and who do not have information and education about their rights. If we fail to reach and engage the people who are furthest behind, we will fail to achieve universal health coverage.

As momentum gathers towards the HLM on UHC, it is critical that dialogue taking place in various fora, including the WHO Africa Health Forum, is aligned. Discussions must inform a robust political declaration on UHC, grounded in the realities that countries face, with tangible measures of success and progress.

We all have a responsibility to join the dots between this forum, the HLM, and other events and meetings on UHC, to ensure people all over the world access their right to health.

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name of person followed by a fullstop.Emma Mulhern
Emma is Sightsavers’ Health Policy Adviser, and is based in the United Kingdom.

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