current concerns 2-008
IMPERATIVE OF
UNIVERSAL HEALTH COVERAGE FOR THE ACHIEVEMENT OF THE SUSTAINABLE DEVELOPMENT
GOALS AND AFRICA’S AGENDA 2063 (2)
-by Dr. Uzodinma Adirieje / +2348034725905
(WhatsApp) / druzoadirieje2015@gmail.com
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VI. The Economic and Social Case for UHC
a. Human capital and growth: Health investments yield high social
and economic returns by increasing labour productivity, educational attainment,
and innovation.
b. Financial risk protection: Prepayment and pooling reduce
catastrophic expenditures and prevent poverty traps.
c. Efficiency: PHC-led systems reduce avoidable hospitalizations,
lower costs, and improve continuity of care.
d. Resilience: Health systems capable of maintaining essential
services during epidemics, conflicts, and climate shocks protect lives and
livelihoods.
VII. Pathways to UHC: Core Building Blocks
The following pathways constitute the core building block for
effective UHC systems:
a. Service Coverage via Strong PHC regimes that define a national
essential health benefits package with explicit cost-effectiveness, equity, and
fiscal realism criteria; expand community health platforms (CHWs, outreach,
school health) with supportive supervision and reliable supply chains; integrate
RMNCAH, NCD prevention and care, mental health, rehabilitation, palliative
care, and SRHR into PHC; and embed public health functions (surveillance,
immunization, vector control, WASH linkages) within PHC.
b. Financial Protection and Progressive Financing regimes that reduce
OOP shares by expanding prepaid, pooled financing: social health insurance,
tax-funded schemes, or hybrid models; improve domestic resource mobilization:
earmarked sin taxes (tobacco, alcohol, sugary drinks), efficiency in tax
collection, and reprioritization of public budgets; enhance pooling and equity:
merge or align fragmented schemes; subsidize premiums for the poor and
vulnerable; and implement strategic purchasing: capitation and diagnosis-related
payments for PHC and hospitals; pay-for-quality with safeguards for equity.
c. Quality of Care and Patient Safety regimes that encompass national
quality strategies, accreditation and licensing, and continuous quality
improvement; safety culture around infection prevention and control,
pharmacovigilance, and respectful care; person-centeredness that promote shared
decision-making, grievance redress, and client satisfaction tracking;
d. Numbers, Skills, and Distribution of Health Workforce that scale
up training and task sharing, expand midwifery, nursing, pharmacy, and allied
cadres; incentivize rural and hard-to-reach deployment: housing, hardship
allowances, career pathways; and protect and motivate workers: fair pay, safe
workplaces, mental health support, and continuous professional development.
e. Medicines, Vaccines, Diagnostics, and Supply Chains that strengthen
procurement transparency, and adopt pooled procurement mechanisms; support
local manufacturing and regional value chains under AfCFTA; enforce regulatory
standards through AMA; and implement real-time logistics management information
systems to prevent stock-outs and wastage.
f. Digital Health and Data Systems characterized by interoperable,
privacy-preserving electronic health records; client registries and unique IDs;
data for decision-making using routine HMIS, civil registration and vital
statistics, geospatial analytics, and AI-assisted forecasting; and telehealth
and mHealth to extend reach, continuity, and self-care.
g. Governance, Accountability, and Community Engagement paradigm
with clear stewardship roles across national and subnational levels, and legal
frameworks for UHC; transparent budgeting, public expenditure reviews, and
citizen-led social accountability; community participation in priority-setting
and monitoring inclusive of health committees, CSOs/NGOs, faith-based
organizations, and professional associations.
VIII. Cross-Cutting Priorities for Africa
There are cross-cutting priority areas to realize the important
place of UHC in achieving the SDGs and Africa Agenda 2063. These include, in no
particular order of priority, the following:
a. Gender Equality, SRHR, and
Ending GBV to ensure that SRHR and GBV services are in the essential benefits
package with removal of user fees that deter uptake; and to expand
adolescent-friendly services by engaging men and boys, protecting bodily
autonomy, and promoting consent.
b. Humanitarian, Fragile, and Conflict Settings by promoting UHC-in-fragility
approaches using mobile clinics, public–private partnerships, and health-worker
protection; maintaining immunization and essential services during crises, by integrating
refugees and IDPs equitably.
c. Climate-Resilient and Planetary Health Systems by recognizing and
addressing the climate-and-health interface through climate-informed planning, early
warning systems, heat-health action plans, and vector surveillance; and greener
health facilities using energy efficiency, renewable power, and climate-smart
supply chains.
d. One Health and Antimicrobial Resistance (AMR) to integrate human,
animal, and environmental health surveillance; and enhance stewardship through optimizing
antimicrobial use; strengthen laboratory networks/referrals, and enforce
infection prevention and control.
IX. Financing UHC: Making It Affordable and Sustainable
Financing is at the core of spreading the benefits UHC, including
the adherence to minimum of 15% annual budgets to Health, as agreed by African
countries during the African Union’s meeting in Abuja, Nigeria in 2001. To this
end, efforts must be made towards budget reprioritization to meet or move
toward continental and global health financing benchmarks; use of innovative
financing such as solidarity levies, diaspora bonds, results-based financing,
blended finance for infrastructure; promoting efficiency gains by reducing
waste, leveraging generic medicines, adopting cost-effective technologies, and
improving provider payment methods; as well as development cooperation aligned
with national plans, and transition strategies for countries moving to higher
income categories.
….. to be continued
Dr. Uzodinma Adirieje is a seasoned
consultant with extensive expertise in global health, climate change,
health/community systems strengthening, development planning, project
management, Sustainable Development Goals (SDGs), governance, policy advocacy,
and monitoring and evaluation (M&E), based in Nigeria. He provides
high-level consultancy services to governments, UN agencies, international
organizations, NGOs, and development partners across Africa, leveraging over 25
years of multidisciplinary experience across Africa and the Global South. He
was the Chair of Nigeria’s national World Malaria Day Committee in 2019;
National President and fellow of the Nigerian Association of Evaluators (NAE)
during 2019 – 2022; President of the Civil Society Organizations Strategy Group
on SDGs in Nigeria (CSOSG); and Chair of the Resource Mobilization
sub-committee of Nigeria’s national World Tuberculosis Day Committee in 2025,
etc. He’s currently President of the African Network of Civil Society
Organizations (ANCSO), and Chair of the Global Consortium of Civil Society on
Climate Change and Conference of Parties (GCSCCC).
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