ALLAN PAMBA: What we should be discussing about universal health coverage

On September 10 the world gathered for the 79th UN General Assembly and as 2030 approaches the focus on health has never been more critical.

All UN member states have set 2030 as the deadline for achieving universal health coverage as part of the sustainable development goals. The goal of universal health coverage is to ensure all people can access the health services they need without suffering financial hardship.

We have just more than five years to go and are at a critical stage, when investment in health systems in low to middle-income countries, many of which are in Africa, is paramount. This includes investments in infrastructure, access to diagnostics and essential medicines, workforce capacity and robust health technologies. It is not a goal any country can achieve in isolation.

The universal health coverage goal is also unlikely to receive an excessive amount of new international funding to expedite the process. So, while pursuing new funding streams from international organisations is undoubtedly still a priority, perhaps governments should first look inward and scrutinise more effective use of existing health budgets to deliver better healthcare.

It has been 23 years since 55 AU states signed the Abuja Declaration, committing to spend at least 15% of their national budgets on healthcare. On average, member countries only spent 7.35% of their national budgets on healthcare that year. By 2021, only two countries had met the Abuja target — Cabo Verde (15.75%) and SA (15.29%).

Diagnostics are the bedrock of effective healthcare. Last year’s World Health Organisation (WHO) resolution on strengthening diagnostics capacity acknowledges that diagnostics enable early detection, accurate treatment and efficient disease management, leading to improved health outcomes and budget cost-effectiveness. 

Preventive care

It is regrettable that the median availability of diagnostics is only 19% in basic primary care facilities surveyed in low income and lower-middle income countries. No surprises there, because now only 2% of healthcare spending is allocated to diagnostics. 

The recent Organisation for Economic Co-operation & Development report “Investing in health system resilience” highlights the necessity of targeted investments to withstand future health crises. Prioritising preventive care — particularly enhancing disease awareness and diagnostic capacity — is crucial for improving health outcomes and driving economic growth.

Given this context, perhaps we could consider that healthcare financing in Africa is first about how we better apportion available funding, and only second about how we raise new funding.

Looking ahead to UN General Assembly 79 in September and anticipating the discussions regarding healthcare financing, two key areas emerge: optimising existing health budgets; and appropriately balancing budgets between diagnostics and treatment. 

Before new funding streams are secured policymakers must make a “trade-off”, or trade-up. Governments must ensure the efficient use of health budgets. With visionary leadership there is scope to reduce wastage of public finances and harness public-private partnerships to stretch available budgets.

Though not perfect, programmes such as Kenya’s managed equipment services, financed by the World Bank, have shown potential for elevating healthcare standards expeditiously. Managed equipment services ensure public hospitals have access to modern health infrastructure, equipment and services over an agreed period, with the government making regular, pre-arranged payments to private sector vendors based on agreed performance parameters.

Eliminating hepatitis

Where there is political will, visionary leadership and committed partners, anything is possible, including universal health coverage. One of Africa’s finest — and most recent — examples of public-private synergy in action is Egypt’s seemingly unprecedented triumph over hepatitis C, a major cause of liver cancer. This cancer was once a leading cause of death in the country and a severe threat to national productivity.

In partnership with the World Bank and Roche Diagnostics, among other key stakeholders, Egypt has effectively eliminated hepatitis C in less than a decade and is the first country to achieve “gold tier” status on the path to eliminating hepatitis C as per the designated WHO criteria. 

Many African families are living on the edge of survival. Like Damocles’ sword, a single catastrophic health event spirals the family into abject poverty, often never to return. New financing models could be cocreated to pool risks. These would provide populations with protection by enabling access to necessary interventions without spiralling into abject poverty (read, universal health coverage). 

African governments should claw back from the unyielding effort to be the dominant player in healthcare delivery. After 60 years of this model it is time to accept it is too challenging from an efficiency perspective. The role of government should instead be heavier on setting strategic direction and priorities, regulation, creating health markets and ensuring equity.

This shift would allow the private sector to deliver healthcare services, filling critical capacity gaps more efficiently. Donor funding should be integrated into national health strategies, moving from vertical programmes to more holistic approaches that address multiple health needs.

UN General Assembly 79 promised to deliver many eye-opening discussions about achieving the 2030 universal health coverage goal in time. The next five years will require consensus and a concerted effort from all stakeholders to prioritise healthcare financing, strengthen diagnostic capacity and establish public-private partnerships to get us over the finish line. 

Strong political will, more efficient use of available resources and innovative financing models will be essential in making universal health coverage a reality, particularly in regions such as Africa that face unique challenges but also harbour many opportunities.

• Pamba is executive vice-president: diagnostics in Africa, at Roche Diagnostics.