Achieving universal health coverage in sub-Saharan Africa: the role of leadership development
Countries world-wide are striving towards Universal Health Coverage (UHC). Financial resources are extremely limited in developing countries and many developing countries are in the midst of multiple interconnected social, economic, epidemiologic, demographic, technological, institutional, environmental and political transitions. According to the World Health Organization (WHO), accelerating progress towards UHC in Africa will require strong leadership. At the recent Global Conference on Primary Health Care (PHC), the Astana Declaration, the world recommitted to comprehensive Primary Health Care as a keystone of Universal Health Coverage. There is evidence that PHC works. Countries that followed the Alma Ata PHC principles have demonstrated population health outcomes and reduced inequalities at low costs as seen in Chile, Cuba, Ethiopia and Rwanda. What seems to be missing is leadership to apply and uphold these PHC principles. There is consensus that if Astana is to be realized, strong political, economic, education, health, science, institutional, and community leaders are needed to make PHC work this time around. Governments and leaders in Africa have been conveying a constant message, that those leading and managing health systems are not sufficiently prepared to succeed in leadership roles they now occupy. Africa has had different leaders with the same results for decades. Leadership development efforts made to date seem not to be producing desired results. Students taken out of Africa to be trained in leadership at western universities, seem to go back home and carry on as usual. Many students have been taken to the West for education, developed great visions and ideas of how they can transfer knowledge learnt, got home and got swallowed by the system. Pumping more money into a health system with no leadership development will not help us achieve ‘Health for All’ in sub-Saharan Africa. How can accountable leadership with a sense of consciousness for social justice be developed successfully in these contexts? If leadership is key for Universal Health Coverage to be achieved in sub-Saharan Africa, is it not high time attention is paid to leadership development approaches.
The definition of Universal Health Coverage (UHC) embodies three objectives namely: i) equity in access to health services-everyone who needs services should get them, not only those who can pay for them; ii) the quality of health services should be good enough to improve the health of those receiving services; and iii) people should be protected against financial risk, meaning ensuring that the cost of using services do not put people at risk of financial harm.
Since the 1978 Alma- Ata agreement on Health for All, the birth of the idea of PHC, significant progress has been witnessed with a 50% reduction in mortality of children under five, improved life expectancy and decreased mortality globally. Yet today far too many preventable deaths still occur. At least half of the world’s population still do not have full coverage of essential health services. About 100 million people are still being pushed into extreme poverty because they have to pay for health care out-of-pocket. Over 800 million people spent at least 10% of their household budgets to pay for health care. One billion people live beyond the reach of a modern health system and do not benefit from public health efforts others take for granted.
PHC status in Africa
African countries have continued to occupy the lowest rung of the ladder in the area of primary health care delivery. In spite of the various global efforts, including funds and technical support, healthcare in many African PHC systems have remained deplorable, unattractive, and irresponsive to peoples’ needs. PHC failed the first-time round in South Africa, because insufficient attention was given to its implementation, resulting in a neglect of taking comprehensive services to communities, disease prevention, health promotion and community participation. Some of the major challenges facing PHC today include inadequate political, financial, human and material commitments, suboptimal use of available resources, challenges in changing management techniques including decentralization and ensuring effective community participation and intersectoral collaboration. The majority of health systems in Africa are characterized by poor leadership and management and absence of health promoting amenities making PHC in Africa fail. Meaningful community participation in PHC has not been achieved to date.