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Commonwealth Health Partnerships 2015

U n i v e r s a l h e a l t h c o v e r a g e a n d c ommu n i c a b l e d i s e a s e s As CHWs are often trusted members of a community, they can play a key role in promoting awareness about diseases and disseminating accurate information. They also provide an important link between formal health structures and primary care provision in communities, assisting in tracking patients and encouraging communities to take part in preventative activities (Lehman and Sanders, 2007). Furthermore, empowered with new technologies and as part of intensified primary health care strategies, CHWs could prove instrumental in gathering the necessary data to help detect, track and contain diseases such as Ebola. They could also give policy-makers accurate information about public health priorities, providing them with a rich window into the lives of the people they serve. This need is particularly strong in rural areas, extending to all age groups and requiring inter-generational solidarity in health care (ibid). CHWs will undoubtedly be a vital link to communities that are currently beyond the reach of formal health systems (FHWC, 2014). However, they should not be seen as a simple cure for all of the problems within Africa’s numerous health systems, nor can we expect them to fulfil the roles of properly trained and specialist health care professionals (HoC IDC, 2014). African commitments to UHC As the world looks to expand access to health services through continued refinement of the post-2015 Sustainable Development Goals (SDGs), a concept that must feature prominently is universal health coverage (UHC). The 58th World Health Assembly defined UHC as ‘access of all population to key promotive, preventative, curative, rehabilitative and palliative health interventions at an affordable cost, thereby achieving equity in access’ (WHO, 2005). In this regard, UHC can be considered a practical expression of the right to health care (Ooms et al., 2014). In the last few years, the global UHC movement has gained increased momentum. While we must acknowledge that not every African nation’s health care requirements are the same, the 2009 Ouagadougou Declaration on Primary Care and Health Systems in Africa proposed a set of useful generic interventions that countries could adopt to strengthen health service delivery (WHO, 2008). Since then, the World Health Assembly and the United Nations General Assembly have called on countries to ‘urgently and significantly scale up efforts to accelerate the transition towards universal access to affordable and quality health care services’ (WB, 2014). Today, some 30 middle-income countries are implementing programmes that aim to advance the transition to UHC, while many low- and middle-income countries are considering launching similar initiatives. In Africa, the 2014 Luanda Commitment on UHC has refocused the need to implement strategies recommended by the Ouagadougou Declaration. All 54 African Union member states pledged to establish the structures and processes required to achieve UHC by 2025, with positive results already being yielded in some African countries following domestic investment in health systems. Rwanda, which has the highest proportion of government expenditure allocated to health on the continent, has seen significant improvements in health outcomes (HoC IDC, 2014). For example, life expectancy has increased from 48 to 58 in the last ten years, deaths of children under five have halved in five years and malaria-related deaths have been reduced by around two-thirds. While figures such as these are encouraging, they still demonstrate that Africa has a long way to go. UHC is certainly an attractive concept. However, public health has to be an economic priority and we cannot ignore challenges related to health financing. An effective health finance system raises sufficient funds to ensure people can use services and are not impoverished by paying for them (HoC IDC, 2014). As of 2011, on average in the African region, government expenditure on health as a percentage of total government expenditure was 9.7 per cent, compared to 15.2 per cent globally. More worryingly still, approximately 56.5 per cent of private expenditure on health was from household out-of-pocket spending (Sambo and Kirigia, 2014). The fact that these payments form more than 50 per cent of private spending on health in 38 (83 per cent) African countries means that millions of people are exposed to financial catastrophe and impoverishment (Sambo and Kirigia, 2014). Conclusion The Malaria Consortium has argued that ‘long-term sustainable change will never be achieved without increased support for countries to develop their own sources of health financing’, with Health Action Poverty advocating a focus on enabling developing countries to collect taxes and tackle tax evasion as urgent priorities (HoC IDC, 2014). However, while increasing revenue collection is necessary, it is not sufficient for greater domestic spending on health. This will require a combination of approaches, including innovative financing, such as taxing tobacco, alcohol, foreign exchange transactions and mobile phone use (TIIFHS, 2009), and better leveraging of the private sector (Sambo and Kirigia, 2014). It also requires facilitating the effective participation of corporate companies in contributing to strengthening health systems and driving greater efficiency in the allocation of health resources. Regarding this latter point and in line with the emphasis on achieving UHC, the Department for International Development (DFID) in the UK has argued that, while outcomes can be improved rapidly in the short-term through disease-specific ‘vertical’ Health as a fundamental human right In line with United Nations Universal Declaration of Human Rights, the WHO constitution states that attaining the highest standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief or economic or social condition (WHO, 2006). Disinvestment in quality health care runs contrary to this, as well as to intra-national obligations. In the Abuja Declaration of 2001 (WHO, 2011), all African countries pledged to increase spending on health to at least 15 per cent of their total government expenditure. In 2012, more than a decade later, only seven African countries had achieved this target, with the majority of countries spending less than ten per cent. As we’ve seen, this under-funding can have a catastrophic effect on national health systems. 58 Commonwealth Health Partnerships 2015


Commonwealth Health Partnerships 2015
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