Universal health coverage (UHC) took centre stage at this month’s United National General Assembly, with world leaders attending the first-ever high-level meeting focused on the issue. In fact, not only did heads of State, health leaders, policymakers and UHC champions attend the meeting but together they obtained “the most comprehensive agreement ever reached on global health”: a commitment to achieving Universal Health Coverage by 2030.
In spite of international stereotypes of healthcare on the continent, African leaders were particularly active in the discussions surrounding UHC. Rwandan President Paul Kagame underlined its importance in his speech, pitching the “transformational potential” of UHC at the top of the global health agenda. He also released an op-ed alongside WHO Director Tedros Adhanom Ghebreyesus, drawing attention to just some of the steps which African nations have already taken toward achieving this ambitious goal.
Indeed, Rwanda has managed to extend health insurance to 90 percent of its population through the Mutuelle de Santé scheme, which has been credited with lowering the country’s maternal and infant mortality rates by 77 percent and 70 percent respectively since the turn of the century. The scheme has been hailed as one of the most successful on the continent, and serves as an example for other developing countries.
“[The Mutuelle de Santé scheme] shows that it is possible for countries at every income level to make health care affordable and accessible for all,” President Kagame told leaders gathered at the UNGA. Kagame also called on world leaders to replenish the epidemic-fighting Global Fund and the Vaccine Alliance, Gavi, existing global initiatives that need to be sustained for the good of Africa- and the rest of the world.
“Universal access to health care is a defining feature of the modern social contract. Good health affords people dignity and enables them to use their talents to the full… No parent should have to choose between food and medicine for their families,” he added.
Senegalese leader Macky Sall also drew on his own country’s experience when he addressed the high-level meeting on UHC. When Sall was first elected in 2012, a mere one-fifth of Senegalese citizens had formal healthcare coverage; the mortality rate for women and men was 168 and 233 per 1,000 adults respectively, and the mortality rate for infants was 55.9 per 1,000 live births. Life expectancy at birth was barely more than 65 years.
Today, the mortality rate for adults is down to less than 6 deaths per 1,000 people, and the infant mortality rate has dropped to 31 deaths per 1,000 live births. Life expectancy has also risen to 67.75 years and is set to continue to rise in the decade to come.
Such significant progress is thanks in no small part to the national agency L’Agence de Couverture Maladie Universelle du Sénégal (CMU), charged with extending healthcare coverage to the whole population, with a target of 75 percent coverage by 2021. Set up in 2015, the agency now provides insurance coverage for roughly 3 million citizens in 552 communities in an attempt to reduce social inequalities.
One way the agency hopes to reach the 2021 milestone is through the launch of a new digital platform designed to boost health coverage via payment digitisation and more reliable record-keeping. Rolled out with the support of several partners, the digitisation of payments initiative falls under a broader agenda launched by Prime Minister Mahammed Abdallah Dionne in November 2018. “The digital transformation of the CMU is the solution provided by Senegal to address the global issue of universal health coverage,” Dionne claims, “its main objective is to enhance the quality of life of its population.”
“The implementation of this platform should accelerate the achievement of the [health-related] Sustainable Development Goals…digital payments are a genuine asset because they reduce costs, increase transactions and facilitate the participation of third parties who want to sign up a close friend or family member,” adds Madam Priya Gajraj, UN Resident Coordinator in Senegal.
But Senegal is not the only country to have made great progress in a surprisingly short time when it comes to providing care to the most vulnerable of its population. Similar leaps forward have been recorded in Kenya, which launched its own pilot phase for UHC, with some 3.2 million people from the Kisumu, Machakos, Nyeri and Isiolo counties to benefit from free, government-provided health services. The UHC package is designed to cater for the unemployed, who are not automatically covered by the National Health Insurance Fund (NHIF) and will include consultation, mental illness and emergency health care services.
According to the World Health Organization, Kenya’s maternal mortality rate remains high at 488 maternal deaths per 100,000 live births. Improvement in the realm of maternal health has been slow. Accordingly, maternal and child health has been identified as key target areas for Kenyan UHC, with households typically spending more on maternal and child health complications due to lack of medical cover. At present, Kenya ranks 39th globally for under-five deaths.
A global goal of universal health coverage – that is, access to quality preventative, curative and palliative health services regardless of an individual’s ability to pay – is a lofty one indeed. Rwanda, Senegal and Kenya have taken important steps towards better healthcare and their experience should be considered by other African countries hoping to improve the wellbeing of their populations. As this year’s UNGA showed, African leaders are ready to take on the challenge.