Old enemies on the road to universal health coverage at 1st WHO Africa Health Forum

By Saleck Dah (pictured) and Gabrielle Szabo

Africa faces “old enemies and new threats” the Director General of the WHO Africa Regional Office told delegates at the first WHO Africa Health Forum in Rwanda last month. The forum – which brought together almost 800 civil society, UN, government and private sector representatives – was an important step in defining the agenda for the region as it works towards universal health coverage under the Sustainable Development Goals.

The “old enemies” at the forum were HIV, TB and malaria. The “new threats”: climate change, urbanisation and non-communicable diseases.

However, pneumonia kills more than five times those old enemies. And with more than half of deaths due to maternal mortality occurring in sub-Saharan Africa, in a continent with a skilled birth attendance rate of 53%, the agenda was conspicuously silent on some of the region’s other oldest enemies.

Save the Children UK and staff from our Mali office attended the forum to learn from experience across the region and to advocate for free-at-point-of-use sexual, reproductive, maternal, newborn, child and adolescent and health services as an essential first step toward universal health coverage. Mali has the sixth highest mortality rate for children under five in the world. Inequality is a key factor – just 28% of poor children with pneumonia were taken to a health provider, compared with 60% of children from the richest families. Nutritional factors are an underlying cause in up to 45% of childhood deaths. Maternal health is equally critical: in 2015 women in Mali faced a 1 in 27 lifetime risk of dying in childbirth or as a result of complications.

In Mali we’re working to save the lives of women and children through integrated programming and advocacy for good-quality services across the continuum of care, from family planning through to safe pregnancies and births, and raising healthy children. We deliver nutrition projects, antenatal care, malaria prevention and response services for pregnant women and children, and case management to prevent parent-to-child transmission of HIV. Our programming has now reached over 1.5 million children.

Beyond services, staff in Mali are working to strengthen health systems for universal health coverage. We’re building governance capacity among community-based organisations so that they can join health associations and manage funds, facilities and information systems. 90% of health needs can be met at the primary healthcare level so Save the Children is advocating for increased funding to integrated community case management and to remove user fees for adolescent reproductive health under the country’s universal health insurance scheme. Governments are listening. In 2017, mayors in nine communes decided to take over a pilot program to motivate and maintain skilled community health workers through payment in recognition of their service and experience.

There are now less than 5,000 days to achieve the Sustainable Development Goals. While the agenda at the first Africa Health Forum was quiet on the most urgent health needs of women and children, participants were not. Speaker after speaker reflected on the importance of “getting the basics right” by strengthening primary healthcare as the first point of contact for women and children seeking essential health services. Save the Children successfully advocated for inclusion of primary healthcare as a priority in the call to action agreed in the forum’s final session. The World Health Organization’s new focus on adolescent health promises a renewed emphasis on sexual and reproductive health rights. But as countries rush to plan their paths toward universal health coverage, advocates must continue to support governments to strengthen health systems and reach every woman and every child.

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