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How do we forge a shared path toward universal health coverage in Africa?

he Action Agenda from the UHC movement, which was developed to inform the preparation for the UN high-level meeting taking place in September 2023, calls for greater and governed multi-sectoral engagement that advances universal health coverage (UHC). This blog highlights how the launch of the UHC Delivery Lab at the African Health Agenda International Conference (AHAIC) in March aligns with collective action to reinvigorate progress toward health for all. Action-oriented projects like these, in line with the set of  action areas outlined in UHC2030’s Agenda, are necessary drivers ahead of the UN high-level meeting on UHC in September.

This month, I had the priviledge to return to Kigali, Rwanda after the launch of the State of UHC in Africa Report to witness next steps toward the delivery of health services for all. Since the report’s launch in 2021, Amref Health Africa has been working behind the scenes to develop the UHC Delivery Lab.

Together with governments, policy shapers, and implementation teams, the aim of the Lab is to resolve challenges faced by different countries – beginning with Senegal, Ethiopia, and Kenya – and support them on their journeys to UHC. It will help countries and institutions contextualize and action the recommendations for UHC in Africa by identifying opportunities for collaboration, designing primary health care systems as a foundation of UHC, and bringing critical stakeholders together to discuss implementing UHC in Africa.

Three points stand out following the launch of the UHC Delivery Lab:

Political leadership for healthier communities and stronger economies

Before the pandemic, improving the state of UHC in Africa was urgent. After COVID-19, it’s an imperative – to address health burdens today and as a bedrock for future global health security.

As shown in the State of UHC in Africa report, less than 50% of people in Africa access the healthcare services they need. This is even lower for women and girls, as well as other vulnerable groups including the poor, disabled, and lesbian, gay, bisexual, transgender and queer (LGBTQ) community. Millions of Africans face financial hardship due to out-of-pocket healthcare costs, or suffer from lack of quality healthcare services. To achieve joint ambitions to leave no one behind and guarantee gender equality in health, this will not do.

African countries have been working toward achieving UHC for the past 20 years. In 2001, African Union countries met in Abuja and committed to allocating at least 15% of their annual budget to sustainable health financing. In the years since, African governments have reiterated their commitments to strive for the equitable health of their populations and achieve UHC, working across sectors to make the its promise a reality.

However, only 37% of countries in Africa have a formal commitment to UHC. While investing in UHC to strengthen health systems can have a high upfront cost, the long-term benefits of a healthier society are key to economic growth and development. UHC should be perceived as an investment not just in health but in stronger economies.

As Paul Kagame, President of Rwanda, said, “The link between health and economic growth is clear. When people aren’t sick in bed or the hospital, they can go to work. But the wider impact of these investments is not always obvious. For example, over the past two decades, every dollar spent on essential medicines in Africa has generated $20 more in social and economic benefits. Every shot of a vaccine into a child’s arm, it turns out, acts like a shot of adrenaline into the heart of the economy.

Sustained political commitments to UHC in Africa are critical, with more African countries enacting UHC policies and legislations that respond to specific population needs, invest in primary health care through systems-wide approaches, back health technologies, and secure adequate financing.

Working in partnerships, engaging private sector

As African countries build back from Covid-19, there is a renewed appetite to engage across sectors to (re)design primary healthcare systems that can manage future health crises as well as ongoing health challenges.

A thriving innovation ecosystem is crucial component of UHC in Africa. According to the World Health Organization, the private sector is both a co-investor and a solutions partner in expanding access to healthcare products and services, as well as building local capacities. It is also an engine to advance new health technologies, techniques, and innovations in service delivery that can improve and efficiently deliver health for all.

Governments must begin to see the true value of private sector in Africa’s health service delivery. UHC2030’s private sector consitituency group, of which IFPMA is part, is playing an important role illustrating private sector commitments and contributions to advance UHC goals in Africa and around the world.

The innovative pharmaceutical industry is already taking action to support a health industries environment in Africa, whether it’s by co-issuing the EU-Africa Business Forum Declaration, calling on African and European business partners to support a health industries environment in Africa, or contributing to the the Partnership for African Vaccine Manufacturing (PAVM).

Building regulatory systems and resilient health care workers

The right enabling environment attracts sustainable investments. We need to work together to advance local manufacturing and production, while also addressing regulatory barriers and strengthening African institutions like the African Medicines Agency.

The African Continental Free Trade Area (AfCFTA), which was signed by most AU member states, also has the potential to bring economic development that strengthens the health sector, expanding markets in ways that incentivize sustainable investments in and reduce trade barriers to healthcare.

We also need a skilled workforce. A stable business environment that respects ethics and encourages local innovation helps to nurture and retain this labour. This includes the labour required to ensure quality production and delivery of health services, from technicians to supply chain managers. Moreover, across sectors – including the private sector – we must contribute to training, retaining, equipping, and protecting healthcare professionals and create opportunities for women – most of our health workers – to thrive.

What cuts across these points is collaboration. The work of the UHC Delivery Lab cannot happen in isolation. All sectors contribute to forging our path toward UHC in Africa. It is the only way that we arrive, together with others committed to the UHC2030 vision of health for all.

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