Over the past two decades, the African region has made progress towards achieving Universal Health Coverage (UHC), with the average Service Coverage Index rising from 23 in 2000, to 44 in 2021 – which means that the African Region is just approaching the halfway mark (of 50 index points) to achieve UHC, with only seven years left to 2030. Worryingly, there has been a stagnation in recent years, in the index due to various factors, such as the negative impact of the COVID-19 pandemic on the provision and utilization of essential health services, limited allocation of resources to health, and gaps in the implementation of comprehensive essential health care packages. Additionally, the increasingly high burden of both communicable and non-communicable diseases (NCDs) has contributed to a slight dip in the regional average from 45 in 2019 to 44 in 2021.
Seven years away from 2030, Member States are still facing challenges in defining, costing, funding, implementing, and monitoring the delivery of essential health packages. In fact, only 17 out of 47 countries (29%) are engaged in the process of developing, reviewing, or implementing a comprehensive essential health services package. This suggests that most African countries have continued to implement basic health packages, which traditionally focus on a limited set of interventions.
The proportion of the population in the WHO African region experiencing extreme impoverishment due to healthcare spending has reduced quite substantially from 45% in 2000 to 14% in 2019. However, the proportion of the population spending at least 10% of their household income on health (catastrophic health spending) has not decreased. While the African Region has the lowest percentage of people who face the risk of catastrophic health spending, it also hosts the largest proportion of people impoverished from health spending.
Over the past two decades, investment in health has been inadequate, particularly from domestic resources and the burden of paying for health care has largely fallen on the population, causing financial hardship. In 2021, only in 10 countries was government funding more than half of current health expenditure; while in 28 countries, more than a quarter of health spending is from out-of-pocket direct payments. Available health resources are also not being used efficiently as the Region lost an estimated US$ 22.9 billion in 2019, due to technical inefficiency of national health systems.
Moving forward, mitigation efforts to get back on track continue to be implemented, with some notable success. For instance, 46 of the 47 member states have been supported to formulate or revise National Health Policies or National Health Strategic Plans, using inclusive, whole-of-society approaches to ensure they remain responsive to the evolving public health landscape and priorities. This also includes support to update the legislative frameworks, coordination, sustainable engagement of actors such as the private sector, and health system reviews to inform reforms.
In addition, the disruptive impact of COVID-19 has substantially been tamed, with only 22% of essential services reported disrupted by the end of 2022 compared to 66% in 2020. This improvement is largely because countries in the region have initiated several recovery and catch-up interventions to recover to pre-COVID-pandemic levels. For instance, for the first time since the COVID-19 pandemic, the coverage of human papillomavirus (HPV) vaccination has surpassed the pre-COVID-pandemic levels, and the proportion of children receiving the first dose of measles vaccine has moved back to the pre-pandemic levels of around 70%). Similar patterns of improvement have been for many other essential interventions.
While we have achieved a lot in our countries, there is still a lot of work that needs to be done to ensure that we build and strengthen the health systems’ capacities to deliver quality and affordable health services to everyone, everywhere, especially the most vulnerable. We ought to ensure that the health systems are resilient enough to withstand the disruptive impacts of health emergencies. We must also sustain, and aim to increase, investment in health targeted at the best buys to gain the maximum benefit from available resources.
The WHO African Region has renewed its focus to support countries to reorganize health systems and align investments with the expectations of UHC. The application of the Primary Health Care approach and its implications on strategic and operational levels is one paradigm shift towards UHC, requiring strong political will, multi-sectoral, whole-of-society coordination, and investments in health systems.
The Region continues to leverage strategic collaborations such as the UHC Partnership and other bilateral health system investments, to foster policy dialogue and actions at national levels to accelerate progress towards UHC targets. These collaborations promote joint working and integration across WHO, Member States, and partners, in line with the AFRO Transformation Agenda. By working together, we can maximize the synergistic impact of our efforts.
The urgency to accelerate progress towards UHC, while at the same time ensuring that future shocks do not set us back, can only be met by building transformed resilient health systems. Resilient, equitable and sustainable UHC is not only a national policy priority for WHO AFRO Member States – there is recognition of the need for solidarity within and across countries, regions, and globally.
In the recent 73rd Regional Committee Meeting in Botswana, and in line with this year’s UHC Day theme: “Health for All: Time for Action”, the Health Ministers of the African Region adopted multiple regional frameworks and strategies to build resilient and sustainable health systems and attain UHC. The Ministers committed to translating the proposed actions of the Regional Committee Meeting into national commitments, with buy-in from the highest levels possible. The frameworks that the Ministers adopted include the Framework for sustaining resilient health systems to achieve universal health coverage and promote health security; the Framework for strengthening community protection and resilience; the Regional Strategy for Community Engagement in the WHO African Region; and the Regional Multisectoral Strategy to Promote Health and Well-being – all covering the period 2023-2030.
Complementary to this, the recently concluded United Nations General Assembly (UNGA) called on countries to repivot their health systems and service delivery modalities to enhance sufficient and uninterrupted access to quality essential health services, including during health emergencies. The assembly recommended that health systems functionality and performance should be tracked regularly at national and sub-national levels, to inform timely interventions to improve the health of the populations.
The overwhelming commitment of African leaders to achieve UHC in their respective countries cannot be understated. We therefore count on you, and on each other’s expertise and support to collectively achieve the health that everyone in the African region and elsewhere in the world wants and should have.
In conclusion, I call on us all within the Region and beyond to leverage the momentum we have all worked hard to generate, to
- advance regional and global efforts that advocate for the reorientation of our health systems, to accelerate the process towards UHC through integrated approaches from national policy dialogue, planning, programming, and delivery.
- leverage unified global and regional strategic support and formalized commitment from stakeholders, to sustain UHC attainment at the top of national health agendas, building on the lessons and reflections from the ongoing public health challenges.