Africa’s health systems unfit to meet needs of the poor, new UHC Report shows

By Adelyn Wangusi

Africa’s health systems are poorly attuned to meet the health care needs of the poor, the State of Universal Health Coverage (UHC) in Africa Report, a comprehensive document that maps the progress of African countries towards their UHC goals and unveiled today by the independent Africa Health Agenda International Conference (AHAIC) Commission shows.

According to the report, the disabled and other vulnerable groups suffer the most, with coverage of essential health care services in Africa being decidedly low: only 48 per cent of the population (approximately 615 million people) receiving the health care services they need.

The report notes that the quality of health care services provided in African countries is also low and is considered the poorest performing indicator of UHC – when the quality of health care services is considered, service coverage scores across African countries are even lower. The report also reveals that coverage of essential services needed by women and girls in Africa is low, with data indicating that between 2015 to 2019, only 49 per cent of African women had their demand for family planning satisfied by modern methods.

The report, whose executive summary was released on the first day of AHAIC 2021 – a biennial convening of health ministers, private sector leaders, civil society and representatives from multilateral organizations taking place virtually from 8-10 March 2021 – highlights the progress made by African countries towards realizing Health for All and details the challenges and opportunities faced by countries on their journeys to UHC. It also provides key recommendations for transformative change, which African countries should adopt to accelerate progress towards UHC.

Compiled between November 2020 and March 2021, the State of UHC in Africa report takes stock of Africa’s progress in fulfilling commitments made by African leaders, such as the Abuja Declaration (2001), the Africa Health Strategy (2007-2015, 2016-2030) and the Addis Ababa Call to Action on UHC (2019). It acknowledges the impact of colonial legacies, poor governance, and economic challenges on the continent’s health policies and outcomes and details the performance of African countries on key UHC indicators, including effective coverage with needed health services, financial risk protection, and health outcomes.

Despite the dismal performance on some indicators, a number of data indications were positive. For example, although the proportion of individuals that are pushed into poverty due to out-of-pocket health care payments each year is high, at 15 million people (representing 1.4 percent of the continent’s population), the number is gradually reducing.

Despite these challenges, the report concedes that the 21st century has seen African leaders show a stronger political will to achieve UHC, creating an opportunity for countries to push the needle on change. The Commission highlights key opportunities that African countries can leverage to accelerate progress towards UHC, including political will, well-trained and competent health professionals, and projected economic growth.

In its recommendations, the Commission proposes several actions to ensure steady progress towards UHC, including re-orienting health systems and health system priorities to respond to population health needs; prioritizing and strengthening primary health care as the foundation for UHC; investing in strengthening health system inputs through, for example, boosting the number of skilled health workers especially in primary health care; investing in health technologies to enhance the performance of all health system functions and strengthening governance and accountability.

Speaking after the launch of the report, Dr. Githinji Gitahi, Global CEO, Amref Health Africa, said: “The COVID-19 pandemic has pointed out the glaring gaps in African – and global – health systems and made a strong case for the urgent achievement of UHC.  While progress towards achieving Health for All has been slow, the current reality has reinvigorated countries’ efforts to ensure better access to quality, affordable health care.”

He added: “Through the State of UHC in Africa report and AHAIC 2021, we are hoping to provide a realistic roadmap 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.”

In addition to the report launch, the first day of AHAIC 2021 also saw attendance from H.E. Uhuru Kenyatta, President of the Republic of Kenya, who in his opening remarks acknowledged the progress made towards Africa’s vision of a continent free of poverty, ignorance, and disease and urged African countries to consider seven priority areas to anchor their health policies and programmes, including giving greater priority to primary health care; increasing access to health care services; making health care more affordable; harnessing Africa’s innovative energy and creativity; strengthening health sector collaboration; improving health security and increasing political will towards UHC.

Also in attendance was World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus, who noted the COVID-19 pandemic’s role in highlighting the centrality of health to the social and economic wellbeing of African nations and called on leaders to boost their nations’ capacities to enhance disease prevention and preparedness to mitigate the impact of disease outbreaks through the greater political commitment.

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