There are signs of progress on the universal health coverage (UHC) front in Africa, but they are are slow and have worsened over time in a few countries, according to the Africa Health Agenda International Conference (AHAIC) commission.

Universal health coverage under the United Nations-mandated Sustainable Development Goals provides access to safe, effective, quality and affordable essential medicines and vaccines with financial risk protection.

AHAIC is an African-led biennial global health conference that took place between March 8 and 10, 2021.

The commission said this in context of key UHC indicators — life expectancy, neonatal mortality rate, under-five mortality rate and maternal mortality ratio.

Between 2010 and 2019, for example, life expectancy improved to 65 years from 55.6 years. This was, however, way behind the global average of 72.5 years. Population of the Central African Republic had the lowest life expectancy in 2019 (53 years).

For every 1,000 live births, around 60 infants (under the age of five) died in 2019, compared to 123 infant deaths in 2010.

AHAIC Commission observed the same in summary of the report titled State of UHC in Africa Report, released during three-day conference. It was organised by the African Medical and Research Foundation.

The independent health commission was set up to review the continent’s progress towards achievement of UHC targets by 2030.

The report, compiled between November 2020 and March 2021, took a stock of Africa’s progress in fulfilling commitments made by African leaders.

Githinji Gitahi, global chief executive, Amref Health Africa, said:

“We are hoping to provide a realistic roadmap through the state of UHC in Africa report and AHAIC 2021, that will guide African countries on their journeys to UHC and to ramp up support for greater multi-stakeholder collaboration across the continent, so that we can move from rhetoric to sustained action COVID-19 and lack of finances derailed the progress on UHC.”

The novel coronavirus disease (COVID-19) pandemic and lack of finances severely derailed the progress on UHC, the commission set up in November 2020 said.

Neo-colonial influence of external institutions has affected Africa’s progress towards UHC. These include low prioritisation and underfunding of health systems along with promotion of user fees due to externally imposed structural adjustment programmes.

UHC and health security are two sides of the same coin, the commission added.

The report said only 48 per cent people in Africa received healthcare services they needed. Nearly 615 million people in Africa may not receive the healthcare services they need.

The report also flagged the wide inequity on coverage of essential health services. For example, the demand for family planning satisfied among the rich was four times that among the poor.

Less than half (49 per cent) African women had their demand for family planning (FP) satisfied by modern methods, the report found.

Despite the dismal performance on some indicators, however, a number of data indications were positive. While the proportion of individuals pushed into poverty due to out-of-pocket health care payments each year 1.4 per cent of the continent’s population, the number has been gradually decreasing.

In fact, out-of-pocket spending on medicines was the leading cause of impoverishing health spending, according to the report.

Opportunities exist

Africa, with 17 per cent of the world’s population, accounts for 23 per cent of the global burden of disease. But it is not all doom and gloom because the continent has immense opportunities that, if leveraged, will accelerate progress towards UHC, according to the AHAIC Commission.

According to the report:

The African Continental Free Trade Area (AfCFTA) that kicked off this year in January, has the potential to stimulate economic development of African countries with knock-on effects on the health sector. It will expand healthcare markets in ways that will incentivise investments in the African health sector.

The report provides a road map for to achieve universal health coverage.  It has called upon the African countries to reorient their health systems and priorities to respond to needs of its people.

Improving health service coverage is dependent on access to quality health workers, according to WHO. The African commission too reiterated strengthening primary health care, the foundation for achieving UHC, said the commission.

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