The journey to Achieving UHC, How far are we? With specific focus on equitable and quality SRHR for all

Delegates at the AHAIC 2019 held in Kigali, Rwanda.


According to the Guttmacher-Lancet Commission, most of the 4.3 billion people in their reproductive age worldwide will lack access to at least one essential sexual or reproductive health service over the course of their reproductive life. In 2018, 214 million women in developing countries had an unmet need for modern contraception, contributing to 67 million unintended pregnancies, 23 million unplanned births, and 36 million abortions. These numbers illustrate huge gaps in access to basic sexual and reproductive health services, posing serious challenges to achieving universal health coverage (UHC) by 2030.

It is now three years since a Framework for Action to implement Universal Health Care (UHC) was launched. Most African countries have integrated UHC as a goal in their national health strategies. However, progress in translating these commitments into expanded domestic resources for health, effective development gains, equitable and quality health services, and increased financial protection, has been slow. What is evident is that there is no one-size-fits-all approach to achieving UHC. Strategies often depend on local circumstance and national dialogue.

Despite the great diversity of African countries, many are facing common challenges and struggles with respect to political leadership, financial sustainability, social norms, multistakeholder involvement among other critical factors for successful implementation of SRHR within UHC framework, thus learning and encouragement from each other is inevitable.

IPPFAR Side Meeting held in Kigali Rwanda 5th March on the margins of the UHAC2019 convened multi a stakeholders (Governments, CSOs, youth, media, private sector) with main objective to reflect and interrogate status quo of UHC in practice. The meeting also aimed to reflect on implementation and document successes and gaps as well as rally calls for new commitments to strengthen implementation of SRHR within UHC.

Of particular interest was the need to address policy environment  enabling availability, accessibility, affordability of community-owned/led, high quality, user friendly wide range SRHR information and services for all including youth, adolescents, women, men irrespective of social status, sex inclination and represented abilities; under the banner: The UHC. Leaving No One Behind. How Far Are We?” Kenya, Uganda, Zambia, Cameroon, Burkina Faso, Ghana, etc were represented.

The Strides

All speakers on panel attested that most African countries have undertaken a number of health system and financing reforms to increase coverage for quality health services, improve availability of essential medicines, and reduce out-of-pocket payments-(financial protection).

The countries are keen to adhere to international frameworks for health including the MDGs, SDGs, Abuja Declaration, Maputo Protocol as well as commitments made at the Family Panning 2020 London summit 2012, which called for urgent and intensified action to accelerate progress to the FP2020 goals and vision of universal access to sexual and reproductive health. Similar struggles such as poverty makes it necessary to prioritise basic health.

Dr Dinah Nakiganda, Assistant Commissioner Reproductive Health, Ministry of Health Uganda attributed Uganda’s milestone to political commitment, strong partnerships, a vibrant private sector and communities that are determined to ensure they get what they want.

The Ministry of Health, Uganda, also realized the importance of upgrading health centres, increasing personnel by hiring and remunerating Community Health Workers (CHWs) to reach everyone in rural areas, staffing health facilities to meet the needs of the growing population, integrating community health services with public sector. She mentioned that Uganda has a health sector monitoring and supervision framework, an elaborate well spread health infrastructure at all levels of national and local government administration and an impressive tracking system for health supplies. In addition the government of Uganda has framed their most recent health sector strategic plan and health financing strategy in the name of achieving UHC by 2025—and plans to roll out a new health insurance scheme that will include family planning in national health insurance schemes within 2018-2022.

On her part, Hon. Sabina Chege Chairperson Parliamentary Health Committee, Kenya, admitted that Kenya still has room and political goodwill to actively engage its young population on the road map to attaining UHC, for it listed healthcare as one of the key pillars to development agenda, alongside affordable housing, food security and manufacturing.

Kenya has hitherto been implementing UHC through abolishing of user fees in dispensaries and health centers since 2013 and launched, in 2018, the pilot phase of UHC in 4 of its 47 counties, with plans to enroll each Kenyan by 2022. Linda Mama free maternity care programme and Beyond Zero Campaign spearheaded by the First Lady of Kenya, -an initiative that involves mobile clinics to reach women from interior parts of the country with the aim to prevent maternal and neo-natal deaths are programs meant to improve SRH services for Kenyan women.

Hon. Dr. Christopher Kalila, MP and Chairperson Parliamentary Committee on Health, Zambia acknowledged that SRHR in Zambia is a priority of the National Health Strategic Plan 2017-2021. All programs in SRHR are aligned to the global, continental and regional frameworks such as; Maputo Plan of Action on Population and Development, Agenda 2063, the SDGs and the SADC framework on SRHR. In the spirit of leaving no one behind, the government of Zambia has preserved a law, to increase access to health insurance from 14%-100%.

Zambia has drafted policies around Adolescents and Young people that have pushed for Comprehensive Sexuality Education (CSE) and now CSE has been incorporated into the syllabus. Zambia’s school re-entry policy, just like Kenya, allows young mothers to enrol back to school and complete their education.

Together with CSOs, Hon. Kalila carrys-out trips to prisons to inspect access to SRH services such as sanitary towels.

Hon Kalila also chairs the Southern African Development Community (SADC) parliamentary forum on SRHR where he ensures that SRHR programs are aligned to the regional health agenda as guided by the SADC Protocol on Health.

Africa’s population is very young. More than 50% of its population is under the age of 25. There is a very high rate of teenage pregnancies and teenage marriages among girls. Davis Mukisa, Family Planning and Adolescents Health, and Co-chair RHRN Alliance Uganda, mentioned that besides policies around Youth and Adolescents, Young people have been actively participating in advocacy and have leveraged on both traditional and social media platforms to voice their concerns. As a result, Youth Friendly Centres have been set up at health facilities to specifically attend to the young people.

The challenges posed

Despite the great diversity of these countries, many face common challenges. Challenges such as; poverty, industrial strikes, human resources issues, corruption, slow implementation of policies, low GDP and dependency on foreign aid. These are major drawbacks to achieving UHC.

Way Forward discussed

Nonetheless, all countries can do more to improve health outcomes and tackle poverty, by increasing coverage of health services, and by reducing the impoverishment associated with payment for health services. Governments can like Zambia, work to have SRH services and supplies included in the basic package of services offered under the UHC strategies, such as national health insurance and hence reduce out-of-pocket health expenditures.

Like Kenya, governments need to abolish user fees at primary health care level. Countries further need to  increase personnel by hiring and remunerating Community Health Workers (CHWs) to reach everyone in rural areas, as well as staff health facilities to meet the needs of men, women adolescents, the elderly and marginalized groups.

Donor funding is insufficient and dwindling. Public financing is necessary to ensure sustainability of sexual and reproductive health and rights (SRHR) investments.  Sexual and reproductive health advocates need to shift focus on domestic resource mobilization (DRM).

The media too has to play the role of highlighting the plight, disseminating information, creating awareness about UHC and holding each one accountable on their roles and commitments they make.

As Dr. Donavine Uwimana, Executive Director, Association Burundaise pour le Bien-Etre Familial’s (ABUBEF)   put it in her call to action remarks; Government partners and other stakeholders – including service providers, researchers, and advocates – must work together to prioritize and invest in comprehensive SRH services and supplies as part of any reform of the health system, including UHC strategies.

Progress toward Countries that achieve their UHC targets by 2030 will eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies, reduce financial hardship linked to illness, and strengthen the foundations for long-term economic growth.

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