PHM-Exch> [PHM NEWS] African Civil Society Statement on Universal Health Coverage- PHM

[Claudio Schuftan]

From: Linda Shuro <linda at phmovement.org>
Date: Wed, Dec 12, 2018 at 12:04 AM

Statement on UHC including video link. Please disseminate widely



*African Civil Society Statement on Universal Health Coverage*



We, members of independent Civil Society in Africa including members of the
People’s Health Movement (PHM)[i], are committed to Comprehensive Primary
Health Care and addressing the Social, Environmental and Economic
Determinants of Health. The Alma Ata Declaration of 1978 defined Primary
Health Care (PHC) as “essential health care based on practical,
scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community through
their full participation in the spirit of self-determination”. It continues
to guide and inform independent civil society work. We make a special
reference to the Alternative Civil Society Astana statement on PHC (*see
link here
<http://phmovement.org/alternative-civil-society-astana-declaration-on-primary-health-care/>*)
which reaffirms the commitment to PHC and calls for action at all levels
and in all sectors to develop and implement PHC throughout the world and
particularly in low and middle income countries in a spirit of technical
cooperation and in keeping with a sustainable and equitable economic order.




To make health care accessible to all, African governments are considering
or have implemented policy reforms with a focus on achieving Universal
Health Coverage (UHC). Examples include, the Community Based Health and
Planning Services (CHPS) and National Health Insurance Scheme in Ghana;
National Health Insurance Scheme in Uganda, expansion of the National
Hospital Insurance Fund in Kenya, National Health Insurance in South Africa
and Health Financing Policy and Strategy in Zimbabwe[ii]. These policy
reforms in different ways aim to provide health financing to protect
populations from impoverishing health care costs.



Despite this momentum, many African countries still provide limited access
to quality health services and only a small percentage of the population is
protected from financial risks associated with health care costs. Health
care is still expensively provided in most African countries and
individuals especially the poor and marginalised quite often struggle to
meet the high fees related to the need to treat illnesses, let alone the
indirect costs of accessing health services. This is evidenced by
continuing poor health care outcomes and increasing inequalities in health
within and between countries in the region. Moreover, the dialogue on UHC
in Africa is strongly influenced by the World Bank and other multilateral
and bilateral donors, which promote UHC as predominantly a health financing
mechanism. Issues of health equity, including a focus on access for the
‘uncovered’ poor, community participation and the strengthening of public
health systems are largely ignored



In these cases, UHC is seen as “a health financing system based on pooling
of funds to provide health coverage for a country’s entire population,
often in the form of a ‘basic package’ of services made available through
health insurance and provided by a growing private sector”[iii]. Here UHC
is framed as a health financing issue, rather than a human right or public
good, and supports charging the poor for health coverage and the creation
of health markets (privatisation). Secure finances for health care are a
necessary but insufficient condition for systems that are equitable and
provide good quality care. Finances need to be channeled through
well-designed public systems if they are to be spent efficiently. UHC is
not only about financing, it is about training health workers, community
participation  including through Health Centre Committees ensuring equity
in healthcare coverage, providing functional, accessible health facilities
and affordable medicines. Creation of separate schemes for different
members of society exacerbates health inequalities within populations and
continues to widen the socioeconomic gap and worsens disparities while
weakening solidarity and capacity for subsidization across different income
groups.



We emphasise that PHC is the key to achieving health for all. Efforts to
achieve UHC should prioritise reviving and strengthening public health
systems in African countries within the Primary Health Care framework which
permeates all levels of health care including addressing social
determinants of health.



This civil society statement on UHC in Africa therefore puts forth the
following actions to strengthen UHC within a Comprehensive Primary Health
Care framework:



*Action needed to ensure that UHC actually brings Primary Health Care for
all, especially the poor*



Action to address social determinants of health ultimately improves health
and everyone should have access to quality health services good enough to
treat or prevent the health problems of people who receive them. That can
only happen when the UHC debate shifts from predominantly financing to
services and population.



*1.         Primary health care*: policies for UHC need to clearly
prioritise PHC at the primary and community levels. Countries that are
already struggling to pay for a portion of their health costs must reduce
those costs, through health promotion and preventive services within a
robust community health system, so that people have less need to access
costly services. A model of UHC built around community-based PHC is both
appropriate and sustainable, and most closely aligns with health rights
enshrined in national constitutions and international conventions and
treaties.



2. *        Social determinants of health*: A whole of government approach
must be applied to support UHC, including Health in All Policies, so that
all ministries and departments of government are coordinated in promoting
healthier working and living conditions and healthy lifestyles, preventing
causes of disease and mortality, and supporting equitable access to health
services. Government policies and actions must be coordinated by the
highest level of political leadership, to act on improving the social
determinants of health.



3.            *Abuja commitment*: Governments should increase health sector
spending to at least 15% of national budgets, as agreed in the 2001 Abuja
Declaration, while directing expenditure to community-level PHC so that
national funds are not wasted on expensive treatments for diseases that
could have been prevented.



4.            *Public financing*: Increase fiscal space by expanding and
improving current tax collection measures; as well as implementing new
taxes that ensure progressiveness and sustainability. Countries can choose
from a wide variety of innovative revenue generation mechanisms as «sin
taxes», levies on mining industries, environmental taxes, and a range of
progressive taxation on air travel, financial transactions, luxury goods
and solidarity levies.



5.            *Pro-poor financing*: Promote health financing systems that
eliminate out-of-pocket expenditure by strengthening prepayment mechanisms
that pool resources, for instance financing from general or targeted tax
revenue without charging users at the point of delivery.



6.             *Eliminate out-of-pocket expenditure for PHC, including UHC:
*Public financing should account for the majority of total health
expenditure, ensuring subsidization of services for the poor and vulnerable
populations. Evidence shows that private (and public) voluntary insurance
schemes are not good models for providing UHC so countries should not rely
on insurance as a financing mechanism. Instead, statutory coverage of the
entire population, including citizens, legal residents and refugees, is
both more efficient and effective in ensuring health for all, even at lower
cost. Statutory protection is more efficient by eliminating administrative
and bureaucratic checks.



7.            *Rational funds allocation*: Allocate national health funds
according to population health needs, ensuring a higher proportion of
resources go to primary health care, health promotion and community
services - thereby preventing disease and illness that require more
expensive, facility-based treatment later.



8.            *Transparency and Accountability* Promote transparency and
accountability in governance and management of health sector resources and
in-service delivery.  As an essential step, governments must involve
independent civil society organizations, labour unions, health workers’
associations, media and communities to take part in health policy
consultations and budget allocation processes; and to monitor budget
expenditure and service delivery quality.



9.     *Leave no one behind*: Strengthen the health decentralization
strategy through subnational governments to improve health service delivery
and identify the hard to reach remote areas and populations with poor
access to and availability of quality healthcare. Ensure all citizens and
residents have equitable access to quality health services across the
country, even with subnational health service provision. Support national
level coordination and support to subnational health service provision, and
reduce administrative costs of health care provision across subnational
authorities.



Many international agencies and NGOs do not understand the African context,
and advocate for a UHC model developed by Western institutions. African
governments need the support of independent civil society - groups that are
not funded by the international agencies and donors - with their own
African model of UHC. In order to develop an African solution that provides
health for all, the first step is to ensure that independent civil society
has a strong voice in the discussions about UHC in Africa.[1]

------------------------------

1 www.phmovement.org

2. Input from PHM Country circles in Africa (Kenya, Uganda, South Africa,
Ghana, Tanzania and Zimbabwe)

3 *OccasionalPaper20_Sengupta_Universal_Health_Coverage_Beyond_Rhetoric_Nov2013
<https://www.municipalservicesproject.org/sites/municipalservicesproject.org/files/publications/OccasionalPaper20_Sengupta_Universal_Health_Coverage_Beyond_Rhetoric_Nov2013_0.pdf>*

UHC Video link:
https://www.municipalservicesproject.org/universal-health-coverage-0
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