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As delegates from 15 countries in Africa descended into Lesotho’s serene city of Maseru, ahead of the 15th Network of African Parliamentary Committees of Health (NEAPACOH) meeting, they were greeted by the breathtaking sight of the country’s picturesque hills scattered across the landscape. The verdant valleys painted a captivating picture, welcoming the visitors to Africa’s “Kingdom in the Sky,” for a two-day meeting to deliberate on healthcare in Africa.
The meeting, held from 27th to 29th February 2024, convened over 150 delegates, including members of parliamentary committees responsible for health, representatives of international organisations, civil society practitioners, academics, and health champions. They delved into critical issues plaguing the African healthcare landscape and crafted a roadmap for action. The convening served as a platform for robust discussions, monitoring progress, highlighting challenges and putting forth key recommendations aimed at transforming healthcare systems.
During the discussions, it became evident that the continent’s progress towards achieving universal health coverage (UHC) is a mixed bag of notable milestones as well as significant challenges hindering its complete realisation.
Progress made in realising universal health coverage
From the different presentations, it was clear that the implementation of UHC varies in progress across countries. Even though there is still much to be desired, the continent is making bold steps.
Namibia finalised its UHC and primary healthcare (PHC) policies. Efforts are now underway to raise awareness among citizens regarding the financial policies associated with these initiatives.
Tanzania launched a UHC programme and established sexual and reproductive health and rights (SRHR) clinics that cater specifically to adolescents, thereby enhancing accessibility and inclusivity in healthcare services using a cross-sectoral approach. The country also aims to include family planning as part of the essential package by 2025 and increase the health budget by 2% using domestic financing.
Zimbabwe rolled out a national family planning programme, increased marriage and sex consent to the age of 18 to end early marriage, and enhanced access to SRHR to reduce teenage pregnancy.
Zambians are guaranteed access to the Essential Package of Health Services. The package encompasses vital healthcare services such as child health and nutrition support, essential drugs and medical supplies, and medical care for malaria, tuberculosis, family planning, and HIV/AIDS, among others.
In the case of Malawi, beside establishing the essential benefit package, Malawi citizens can seek medical attention and treatment without having to worry about financial barriers at the point of service.
In Kenya, parliament passed various pieces of legislation to govern the roll out of UHC. Efforts are underway to establish comprehensive regulations that will provide the necessary framework and support for the effective operation of the UHC programme.
Significant strides have been made in Uganda to promote the fusion of health considerations into the national climate change adaptation strategy. This is a move that seeks to bolster the resilience of both health systems and local communities in the face of environmental challenges.
Challanges countries are experiencing
Insufficient budget allocation is a thorn in the flesh to the health sector. Speaker after speaker echoed a resounding call for parliamentarians to leverage their legislative authority in advocating for increased funding towards healthcare. They underscored the critical role parliamentarians play in addressing this crucial issue and ensuring improved access to quality healthcare services for all.
Another challenge indicated was fragmentation in the health sector. Ms. Emily Chirwa, Deputy Director of Planning and Policy at the Ministry of Health in Malawi, particularly highlighted that in Malawi, fragmentation is a challenge. The government of Malawi manages 40% of all available resources, while 60% are managed by over 200 implementing partners including the private sector, NGOs, and donors. Presenters from other countries shared similar experiences – an indication that this is an issue needing urgent attention. Fragmentation often arises from disjointed efforts and resources allocated to different healthcare initiatives, leading to inefficiencies and gaps in service delivery.
Also, dependency on external donors and user fees for healthcare funding was highlighted as stumbling blocks in the journey towards UHC. Donors are exiting the scene, posing a significant risk to healthcare systems. Overreliance on user fees is unsustainable and costly for common citizens. During a keynote, Dr Jackson Otieno, AFIDEP’s Senior Research and Policy Analyst, noted that African countries continue to rely on user fees or out-of-pocket (OOP) expenditure, with Uganda, Kenya, Burundi, and Tanzania leading with more than 20%. To cushion citizens against catastrophic health expenditures, countries were advised to reduce OOP expenditure to less than 15%.
Recommendations
The role of health insurance in protecting households from financial distress was a key topic of discussion. Compulsory payments based on income and subsidisation were highly recommended, and some countries pursuing compulsory NHI include Kenya, Zambia and Ghana. Dr Samson Kuhora, from Kenya’s National Health Insurance Fund (NHIF), emphasised the importance of the private sector’s involvement in health insurance schemes and highlighted the need for policy reforms to ensure financial protection for all citizens. However, there is need to increase the commodities covered by NHIs to include reproductive health and family planning.
The discussions at NEAPACOH also examined how to use the minimum available resources to achieve the greatest wins. Countries were advised to reduce inefficiencies brought about by fragmentation within health insurance systems by consolidating and integrating multiple insurance schemes into a unified system. Furthermore, reducing the cost of administration, ensuring effective public debt management by diversifying sources of income and debt refinancing, and taming corruption in the public health sector by strengthening legal frameworks and enhancing transparency and accountability can improve the functioning of health systems.
Another approach is imposing taxes on products like tobacco, alcohol, and sugary beverages. The move will provide disincentives for people to engage in harmful habits, and help reduce the burden on health systems associated with the widespread consumption of these products.
A cross-sectoral approach, for instance, the health sector getting funding from linked programmes in environment and climate change could be a viable option. On integrating health and climate action, AFIDEP’s BUILD Project Director, Mr Clive Mutunga, at the event, urged the parliamentarians to institutionalise cross-sectoral population, health, environment and development (PHED) approaches, and engage with other sectors’ parliamentary committees e.g., environment and climate committees for joint advocacy and legislation. This can help ensure that health, and particularly family planning, is central to sub-national, national, regional, and global climate change action.
Call to action
As the event ended, parliamentarians committed themselves to enhance oversight and accountability by monitoring the allocation and use of health-related funds across sectors like education, agriculture, water, transport, and environment. They also committed to fostering multisectoral engagement for improved emergency preparedness and response within resilient health systems.
Additionally, they agreed to strengthen scrutiny of health budgets to minimise wastage and inefficiencies and bolster South-South Cooperation, raising parliamentary awareness and contributing to global health security negotiations. This also involves facilitating knowledge sharing and best practice exchange in PHED through platforms such as the UN Climate Change Conference.
Conclusion
NEAPACOH 2024 served as a catalyst for collaboration, innovation, and transformative change in healthcare across Africa. As countries continue to work towards achieving UHC and strengthening their healthcare systems, the conference provided valuable insights and actionable strategies to drive progress and improve health outcomes for all citizens. AFIDEP will continue supporting legislators across the continent, providing them with evidence to make sound decisions. The NEAPACOH event was organised by Partners in Population for Development – Africa Region Office and other partners including AFIDEP.