<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><br><div class="gmail_quote"><div dir="ltr"><br>From: <b class="gmail_sendername" dir="auto">Linda Shuro</b> <span dir="ltr"><<a href="mailto:linda@phmovement.org">linda@phmovement.org</a>></span><br>Date: Wed, Dec 12, 2018 at 12:04 AM<br></div><br><div dir="ltr"><div dir="ltr"><div dir="ltr"><p class="MsoNormal" style="text-align:center" align="center"><span style="font-size:18.6667px">Statement on UHC including video link. Please disseminate widely </span></p><p class="MsoNormal" style="text-align:center" align="center"><b><span style="font-size:14pt;line-height:115%" lang="EN"><br></span></b></p><p class="MsoNormal" style="text-align:center" align="center"><b><span style="font-size:14pt;line-height:115%" lang="EN"><br></span></b></p><p class="MsoNormal" style="text-align:center" align="center"><b><span style="font-size:14pt;line-height:115%" lang="EN">African Civil
Society Statement on Universal Health Coverage<span></span></span></b></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN"> </span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN">We, members of independent
Civil Society in Africa including members of the People’s Health Movement (PHM)<a name="m_-7329927626856465962__ednref1" title=""><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span style="font-size:11pt;line-height:115%;font-family:Arial,sans-serif" lang="EN">[i]</span></span></span></a>,
are <span style="background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial">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 (<u><a href="http://phmovement.org/alternative-civil-society-astana-declaration-on-primary-health-care/" target="_blank"><span style="color:windowtext">see link here</span></a></u>) 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. </span> <span style="background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial"><span></span></span></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="color:rgb(58,58,58);background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial" lang="EN"><span> </span></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN">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<a name="m_-7329927626856465962__ednref2" title=""><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span style="font-size:11pt;line-height:115%;font-family:Arial,sans-serif" lang="EN">[ii]</span></span></span></a>.
These policy reforms in different ways aim <span style="background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial">to provide health financing to protect populations from
impoverishing health care costs. <span></span></span></span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN"> </span></p>
<p class="MsoNormal" style="text-align:justify"><span lang="EN">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 <u><span></span></u></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial" lang="EN"><span> </span></span></p>
<p class="MsoNormal"><span lang="EN">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”<a name="m_-7329927626856465962__ednref3" title=""><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span style="font-size:11pt;line-height:115%;font-family:Arial,sans-serif" lang="EN">[iii]</span></span></span></a>.
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. <span></span></span></p>
<p class="MsoNormal"><span style="color:red" lang="EN"> </span></p>
<p class="MsoNormal" style="text-align:justify"><span style="background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial" lang="EN">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.<span></span></span></p>
<p class="MsoNormal" style="text-align:justify"><span style="background-image:initial;background-position:initial;background-size:initial;background-repeat:initial;background-origin:initial;background-clip:initial" lang="EN"><span> </span></span></p>
<p class="MsoNormal"><span lang="EN">This civil society statement on UHC in Africa
therefore puts forth the following actions to strengthen UHC within a
Comprehensive Primary Health Care framework: <span></span></span></p>
<p class="MsoNormal"><b> </b></p>
<p class="MsoNormal"><b>Action
needed to ensure that UHC actually brings Primary Health Care for all,
especially the poor<span></span></b></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">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.<span></span></span></p>
<p class="MsoNormal" style="margin-left:0.5in"><span lang="EN"> </span></p>
<p class="MsoNormal"><i>1. Primary health care</i><span lang="EN">: 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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">2. <i> Social determinants of health</i>: 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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">3.</span><span style="font-size:7pt;line-height:115%" lang="EN"> </span><i>Abuja commitment</i><span lang="EN">: 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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">4.</span><span style="font-size:7pt;line-height:115%" lang="EN"> </span><i>Public financing</i><span lang="EN">: 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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">5.</span><span style="font-size:7pt;line-height:115%" lang="EN"> </span><i>Pro-poor financing</i><span lang="EN">: 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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">6.</span><span style="font-size:7pt;line-height:115%" lang="EN"> </span><i>Eliminate out-of-pocket
expenditure for PHC, including UHC: </i><span lang="EN">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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">7.</span><span style="font-size:7pt;line-height:115%" lang="EN"> </span><i>Rational funds allocation</i><span lang="EN">:
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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">8.</span><span style="font-size:7pt;line-height:115%" lang="EN"> </span><i>Transparency and Accountability</i><span lang="EN">
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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">9. <i>Leave no one behind</i>: 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.<span></span></span></p>
<p class="MsoNormal"><span lang="EN"> </span></p>
<p class="MsoNormal"><span lang="EN">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.<a name="m_-7329927626856465962__ftnref1" title=""><sup><sup><span style="font-size:11pt;line-height:115%;font-family:Arial,sans-serif" lang="EN">[1]</span></sup></sup></a><span></span></span></p>
<div><br clear="all">
<hr width="33%" size="1" align="left">
<div id="m_-7329927626856465962gmail-ftn1">
<p class="MsoNormal" style="line-height:normal"><a name="m_-7329927626856465962__ftn1" title=""></a></p></div></div><div>
<div id="m_-7329927626856465962edn1">
<p class="m_-7329927626856465962gmail-MsoEndnoteText"><a name="m_-7329927626856465962__edn1" title=""></a><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span style="font-size:9pt" lang="EN">1</span></span><span style="font-size:9pt" lang="EN"> </span><span style="font-size:9pt" lang="EN-US"><a href="http://www.phmovement.org/" target="_blank">www.phmovement.org</a> <span></span></span></p>
<p class="m_-7329927626856465962gmail-MsoEndnoteText"><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span style="font-size:9pt" lang="EN">2. </span></span><span style="font-size:9pt" lang="EN">Input from PHM Country
circles in Africa (Kenya, Uganda, South Africa, Ghana, Tanzania and Zimbabwe)</span><br></p></div><div id="m_-7329927626856465962edn2">
<p class="m_-7329927626856465962gmail-MsoEndnoteText"><span class="m_-7329927626856465962gmail-MsoEndnoteReference"><span style="font-size:9pt" lang="EN">3</span></span><span style="font-size:9pt" lang="EN"> <u><span style="color:rgb(17,85,204)"><a href="https://www.municipalservicesproject.org/sites/municipalservicesproject.org/files/publications/OccasionalPaper20_Sengupta_Universal_Health_Coverage_Beyond_Rhetoric_Nov2013_0.pdf" target="_blank">OccasionalPaper20_Sengupta_Universal_Health_Coverage_Beyond_Rhetoric_Nov2013</a></span></u></span><br></p></div>
</div><div><br></div><div>UHC Video link: <a href="https://www.municipalservicesproject.org/universal-health-coverage-0" target="_blank">https://www.municipalservicesproject.org/universal-health-coverage-0</a> </div><br></div></div></div>
</div></div>