Country ownership and global health partnerships critical in achieving Universal Health Coverage

By Tawanda Chisango1

Political and global health leaders meeting mid-December on the sidelines of the universal health coverage meeting in Tokyo discussed pathways to strengthen country led efforts supported by global partnerships to achieve universal health coverage. While the meeting focused on the imperative for country ownership, domestic health financing and sustained leadership and commitment for equitable health and universal health coverage, it underscored the importance of global health partnerships in Africa’s health agenda. Global health partnerships are a cornerstone for universal health coverage hence the event sought to highlight the contribution of these partnerships in moving the universal health coverage agenda forward. Here are the key takeaways from the meeting on how global health partnerships are shaping the health agenda in Africa.

What do global health partnerships entail?

Global health partnerships are entities that were established in the 21st century to undertake focused efforts to address global health challenges. They bring together governments, civil society, international organisations, the private sector and affected communities and advance multi-sectoral efforts to streamline health cooperation with a focus on specific health issues. Their goal is to achieve health improvements that no organisation could achieve alone. The Global Fund and GAVI represent examples of global health partnerships, along with others such as Stop TB Partnership, Roll Back Malaria, UNAIDS and many others.

With clear health mandates, these innovative public-private partnerships contribute to remarkable epidemiological impact by reducing the prevalence and incidence of major diseases of global health importance. At the same time, they also bring substantial effect to countries’ national health systems. These institutions play a central and critical role in translating global goals into effective investment strategies, saving millions of lives and successfully altering the trajectory of epidemics.

What does it take to achieve Universal Health Coverage?

Achieving universal health coverage requires a portfolio of investments in both hardware and software elements of a public health system. This includes ensuring that the health workforce is enhanced, ensuring that motivated, productive and fit for purpose health workers, health infrastructure, medical products and technologies are put in place. Furthermore improved service delivery to ensure rational and effective delivery of essential interventions to maintain health and health governance to establish facilitative mechanisms for making policies and promoting accountability are equally critical. Health information, research and innovation and health financing are also essential components for achieving the universal health coverage agenda.

Optimising health financing is central to making effective progress towards universal health coverage and in particular to reducing the gap between the need for and use of services and improving financial protection. While private funds play a role in all health systems, evidence shows that it is public, compulsory, pre-paid financing that helps countries move towards universal health coverage. Low levels of public financing are associated with reduced overall financial protection and worsened health outputs.

What panelists said about universal health coverage

‘We cannot achieve the sustainable development goals if we do not address the universal health coverage agenda and end the epidemics of AIDS, tuberculosis, malaria and other new emergencies. Senegal is moving towards universal health coverage and has already made remarkable progress. In 2015, the government set up the universal health insurance agency (CMU Agency) and in 2017 the budget allocation for health was raised to nearly 25 billion CFA francs’ - Dr. Bocar Mamadou Daff, Senegal Ministry of Health.

‘Kenya is committed to implementing health system reforms to accelerate movement towards universal health coverage and realize the right to health. The health system reforms target improvements in availability of health infrastructure, training, health information management and equitable health financing systems’ -Dr. Cleopa Mailu, Cabinet Secretary, Ministry of Health of the Republic of Kenya.

‘In the Sudan, there has been a strong commitment to protect citizens from catastrophic health expenditures to ensure healthier communities and a stronger and more resilient economy. In early 2016 the Sudanese government passed a new law that mandates that every citizen has access to health insurance and care services without facing financial risk’ said Dr. Bahar Idriss Abu Garda, Minister of Health of the Sudan.

‘To harness the demographic dividend and achieve the socio-economic and structural transformation of Africa’s Agenda 2063, it is clear that health has to be put at the centre. The AU is implementing the Africa Health Strategy for the next 15 years to achieve universal health coverage through promoting social protection, ensuring access to quality assured and affordable medicines, health financing, human resources for health, improved governance and accountability and multi-sectoral collaboration and partnerships’ - Dr. Marie-Goretti Harakeye, African Union Commission.

 ‘Investments made by the Global Fund have expanded access to essential health services and advanced universal health coverage by helping countries provide equitable and financially accessible health services to the most vulnerable’ - Dr. Marijke Wijnroks, The Global Fund to Fight AIDS, Tuberculosis and Malaria.

 ‘Gavi, the Vaccine Alliance, welcomes the international community’s commitment to universal health coverage. Immunisation is a well-defined first step towards this goal and can pave way for other free-of-charge, prevention focused services to reach populations through the public health systems. Immunisation is a starting point for building primary health care and public health system core capacities. Gavi, the Vaccine Alliance will continue to accelerate innovations, implemented at scale to contribute to Universal Health Coverage’ - Marie-Ange Saraka-Yao, GAVI, The Vaccine Alliance.

1 The writer manages the health communication portfolio in the Department of Social Affairs at the African Union Commission.