Africa, partners must chart course toward universal health coverage

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Africa needs much more investment from the private sector to build its roads, energy and communications infrastructure. But for countries to make the most use of that infrastructure, they also need to invest more in people – in brain power and “gray matter” infrastructure, to realize their demographic dividend that fuels inclusive economic growth.

This week in Nairobi, Kenya, at the sixth Tokyo International Conference on African Development, African countries and their partners must grasp this unprecedented opportunity to chart a course toward universal health coverage, or UHC. This initiative, which is being led by the government of Japan, a global champion of UHC, is critical to Africa’s future growth and prosperity. The World Bank Group will announce today a $15 billion commitment over the next five years to accelerate universal health coverage in Africa.

Better health and survival rates – particularly for mothers and children – are linked to economic growth. The evidence is overwhelming: The Lancet Commission on Investing in Health found that survival gains contribute disproportionately to economic growth in Africa. Improved early childhood nutrition, early stimulation and early learning programs extend school completion and improve learning outcomes, and in turn, increase adult wages. The commission also found that investments in universal health coverage pay off at a rate of as high as 10 to 1.

Our alignment around UHC needs to, first and foremost, assess the current state of health in Africa. Continued high levels of mortality for mothers and children, along with high rates of under nutrition, are top priorities where accelerated progress is possible and necessary.

These must be balanced with the growing demands for chronic care associated with non-communicable diseases such as high blood pressure and diabetes. Africa’s brave and successful struggles with neglected tropical diseases such as guinea worm and river blindness, along with its meteoric progress in the fights against malaria and HIV, are evidence of what is possible.

Yet the recent outbreaks of Ebola, yellow fever, and new cases of polio in Nigeria are sobering reminders of the shared responsibility that all countries have in making sure that their health services are not only universal in name – but in practice. Against this challenging landscape of health needs, African leaders need to embrace ambitious reforms in services and financing.

Frontline primary health care services led by community health workers, with appropriate referral for essential hospital care and emergency outbreak response capacity, are the defining service pillars of universal health coverage. Breakthroughs in these models of care are in evidence across the continent.

But universal coverage of essential services requires a fundamental shift in the way health care is financed. UHC means changing from a pay-as-you-go system – which punishes the poor for being sick and led to the impoverishment of more than 11 million people in Africa in 2014 alone – to pre-paying for health, which promotes prompt access when people are ill, and protects the poor.

We need to put money directly in the hands of poor women, through cash transfer programs that offer universal health, education and nutrition entitlements to these women and their children, and are strongly associated with inclusive growth.

Donor assistance needs to more effectively support UHC expansion in countries. Through the Global Financing Facility, we are working with countries to achieve smarter, scaled and sustainable financing for their health sectors.

We know, however, that even the best-prepared and financed health systems can be overwhelmed in the context of an epidemic. This is why at the G7 meeting in May, we launched the Pandemic Emergency Financing Facility, an innovative, fast-disbursing global financing mechanism designed to help stop the next outbreak before it becomes an epidemic.

We must continue to invest in what works – such as the scale-up of bed nets to protect people from malaria, the use of drones to deliver life-saving medical supplies to remote villages, and the deployment of thousands of new community health workers across Africa. We can harness this potential more systematically and ultimately create more jobs while delivering better health outcomes.

With the right investments, we can save the lives of millions of people, help people lift themselves out of extreme poverty, and ensure that all people are healthier and live longer and more productive lives. This is within Africa’s reach, and one foundation for the prosperity of the continent will be commitments to universal health coverage.

(The author is President of the World Bank Group)

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