Blog: Key reflections from the Tea with Africa session on Universal Health Coverage – will equitable, accessible, viable healthcare be a reality by 2030?
‘Tea with Africa’: Introduction
The Tea with Africa series is part of The George Institute’s initiative aimed at promoting authentic partnerships with health researchers, institutions, and communities in Africa. The third session of this thought-provoking online conversation series held on the 31st of August 2022. The topic of discussion was 'Universal Health Coverage (UHC) – will equitable, accessible, viable healthcare be a reality by 2030?’. A panel of four speakers briefly shared different perspectives to set the scene, followed by a facilitated discussion with the audience. They provided a brief overview of the current situation, regarding UHC, insights on what is working with examples, and ideas for the future.
Dr. Olive Kobusingye hosted the event, initiated the discussion by providing an overview of UHC. She talked about promoting healthy life through financial risk assistance, and the progress being made in Africa related to vaccination for all.
An overview of the presentations
The first speaker Dr. Mamadou Selly Ly provided an overview of the current situation in a presentation titled, ‘15 years of reforms in Africa for Universal Health Coverage (UHC) and financial protection: where are we now?’
Dr Selly Ly presented a framework for health systems development useful for understanding progress towards attaining UHC in the WHO African Region. Dr Selly Ly approached the issue in two different ways. First, he focused on countries that have formally and explicitly initiated UHC reforms. He explained that for most of these countries, UHC means ‘Universal Health Insurance’. He discussed how good health and wellbeing can be achieved, mentioned that 60% of countries in Africa do not have universal financial risk protection schemes in place, and shared a geographic representation of these details using an annotated map. He then presented the UHC results for countries in the WHO African region. Dr Selly Ly also talked about the Essential Health Services Coverage Index with four broad components (reproductive, maternal, new-born and child health, infectious disease control, non-communicable disease and lastly, service capacity and access) in different parts of Africa. He also showed how countries in Africa have fared overall on the UHC index. Dr Selly Ly concluded that there has been slower progress with the provision of Universal Health Coverage for chronic diseases compared to communicable diseases, maternal and child health. Although catastrophic spending has reduced across the continent, African countries with universal health financial risk protection schemes are in the minority.
Dr. Blake Angell spoke next on ‘Stronger investment for stronger health systems: Addressing key challenges on the path to Universal Coverage.’
Dr Angell started the presentation with a systematic analysis of health system coverage in Nigeria and contrasted its performance with other countries in West Africa. Dr. Angell mentioned that there are ongoing efforts to improve UHC coverage in Nigeria with resultant change in mortality rates. Regarding health expenditure, Dr Angell made specific reference to the potential for cross-cultural learning between African countries with huge gains to be made especially for the young and the poor. Dr Angell talked about maternal, neonatal and child deaths possibly averted under different levels of coverage across Nigeria between 2021-2030. According to him, health workers (especially primary care providers) need to be trained and dispersed across the country, but this requires much more than just money. Many countries spend a lot on policies that have not yielded the desired impact. Hence, there should be more focus on evidence-based policies that improve efficiency of health systems in Africa, leading to retention and motivation of its health care workforce.
Dr. Emmanuella-Faith (Ella) Amoako was the third speaker. She spoke about ‘Making the Unseen Visible - How a shared care model is transforming childhood cancer care in Ghana.’
Dr Amoako began her presentation by providing insights on the burden of childhood cancer in Ghana. In 2016, the Ghanaian population aged 0-14 years was approximately 38%. Ghana has two childhood cancer comprehensive treatment centres. Even though about 1200 are expected to be diagnosed with cancers each year, only about 300 children are able to receive care at these health facilities. Additionally, there are diagnostic and treatment delays which lead to lower cure rates. Dr Amoako talked about an initiative designed to improve access to treatment for childhood cancers in Ghana. It involved a shared-care network of paediatric cancer wards made up of a hub-centre and satellite centres across Ghana, equipped with advanced facilities for providing co-managed patient care and follow up. The shared-care network increased total number of cases seen and diagnosed by 23%. In her presentation, Dr Amoako mentioned that partnerships with various institutes have helped them improve the access to cancer care substantially.
Dr. Kenneth Yakubu was the final speaker, and his presentation was titled, ‘Moving forward on Universal Health Coverage: Ideas for sustainable progress’.
Dr Yakubu explained the connection between health worker density and UHC. He then commented on prevailing health worker shortages and the implication for health services in Nigeria and in Africa. Dr Yakubu highlighted health worker migration as an important factor influencing availability of health workers and by extension, UHC. While migration is an age-old phenomenon that cannot be stopped, its governance can be improved to ensure access to health services is protected in both source and destination countries. Dr Yakubu then presented findings from a study conducted in Nigeria aimed at deriving a governance framework for skilled health worker migration. Some of the recommendations from this study include the need for accountability mechanisms inspired by human right norms. Creating these accountability mechanisms will require collective action involving state and non-state actors. In addition to human right principles, promoting accountability will also require reliance on societal norms that can drive collective action towards a sustainable attainment of UHC.
Questions from the audience
After the presentation, Dr. Kobusingye took questions and comments from the audience. Some of the questions and responses from the speakers have been provided below:
Question: How do we address the continuing brain drain as people will move migration is natural?
Dr. Yakubu- There is little we can do stop migration of health workers. However, it is possible to adopt a participatory approach to understanding and addressing. The success rate would be higher if relevant actors within and outside a country subscribe to a system of accountability that is right’s-based, promoting collective action for addressing the situation.
Question: Do we need more investment towards the health workforce?
Dr. Blake agreed with Dr. Yakubu that it is unacceptable for low- and middle-income countries (LMIC) to invest in training health workers only to lose them to high income countries. There is a need for compensation. There is also a need for migration data systems robust enough to capture migration flows, losses, and benefits. Beyond retaining and maintaining an adequate health workforce, there also needs to be more investment by governments in source countries to reduce out of pocket cost health expenditure.
Dr. Mamadou Selly Ly mentioned that improving access to care has been the priority of governments in Africa over decades. While governmental action has led to some favourable results, a lot more needs to be done. Earlier focus of governments has been improving the supply of health services, a lot more progress can be achieved if demand is increased as well. In addition, political leaders in Africa need an evidence-informed tool kit for policy making and implementation.
Question. How can financial barriers be removed allowing health workers gain access to essential medicines and equipment’s?
Dr. Amoako mentioned that Government Health Insurance in Ghana does not cover childhood cancer and there is a reliance on donor funding which is not sustainable in the long run.
Final Remarks from the Panelists
The questions elicited further discussions after which Dr Kobusingye invited each panellist to provide a final remark.
Dr Yakubu: Sustainable progress towards UHC will require collective action involving state and non-state actors. The mobilisation for collective action and its sustenance should be norms driven. We should take note of existing societal norms that can help promote accountability among stakeholders, but not lose sight of the frameworks human right principles provide.
Dr. Amoako: No child should be denied care wherever they are born
Dr. Angell: agreed with Dr Yakubu and added that mobilisation of public support for increased care coverage will be vital to achieving progress and ensuring governments properly finance and invest in population health.
Dr. Selly Ly: We must increase public fund work on healthcare. Political will is also essential. Finally, African countries should continue to focus on primary health care.
Dr Kobusingye thanked everyone for their wonderful presentations and specified that the conversations should be taken forward. She mentioned few key points from the discussion and how insightful it was which left us pondering over so many points.
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About the speakers
- Dr. Emmanuella-Faith (Ella) Amoako Head of Clinical Affairs at Yemaachi Biotechnology, Ghana. A Paediatric Oncology fellow at the Korle Bu Teaching hospital, Ella has a keen interest in oncogenetics and has extensive experience working in resource limited settings. Ella established an Oncology shared care unit at the Cape Coast Teaching hospital which helps to improve patients’ access to care. Ella is a strong advocate for children and believes cancer care and research in children must be diverse.
- Dr. Blake Angell Senior Research Fellow in the Health Systems Science program at the George Institute for Global Health, a Conjoint Senior Lecturer at the Faculty of Medicine and Health UNSW Sydney Australia, and an NHMRC Emerging Leadership Fellow. Blake is a health economist conducting research on the equity, efficiency, and incentive impacts of health policy in health systems around the world.
- Dr. Mamadou Selly Ly Director of Legal Affairs and Partnerships, National Agency for Universal Health Coverage, Senegal. Among many publications, Mamadou is lead author of the recent paper, ‘Universal health insurance in Africa: a narrative review of the literature on institutional models’ (BMJ Global Health).
- Dr. Kenneth Yakubu Family physician from Nigeria and PhD candidate in the Health Systems Science Unit at The George Institute. Yakubu’s research focuses on right’s-based perspectives for interpreting and addressing global health worker shortages. He is also co-lead of the Institute’s Africa Initiative to expand research engagement in the continent.
About the host
Dr. Olive an accident & emergency surgeon, injury epidemiologist, and published author. She is Director of the Trauma, Injuries and Disability programme at the Makerere University School of Public Health in Kampala, Board Chair of The Road Traffic Injuries Research Network, and co-founder of The Great Outdoors, Uganda.
