University of BonnMasters on Global Health Risk Management and Hygiene PoliciesBuilding Universal Health Coverage Temple in AfricaPrepared and designed by Abenezer Giberhiowt Bonn, Germany 9/21/2018Table of Content TOC o "1-3" h u HYPERLINK l _Toc9651 Chapter one PAGEREF _Toc9651 1 HYPERLINK l _Toc3544 1. Introduce PAGEREF _Toc3544 1 HYPERLINK l _Toc4383 1.1 Global Initiative Towards Universal Health Coverage PAGEREF _Toc4383 2 HYPERLINK l _Toc7316 2. Universal health coverage in Africa PAGEREF _Toc7316 3 HYPERLINK l _Toc8456 2.
1 Building UHC Temple in Africa PAGEREF _Toc8456 5 HYPERLINK l _Toc11045 2.1.1 Peace, Good Governance and Leadership PAGEREF _Toc11045 5 HYPERLINK l _Toc25234 2.1.2 Health Financial PAGEREF _Toc25234 6 HYPERLINK l _Toc9839 2.1.
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3 Health Information PAGEREF _Toc9839 7 HYPERLINK l _Toc6686 2.1.4 Human Resource for Health PAGEREF _Toc6686 8 HYPERLINK l _Toc18482 2.1.5 Medical products, Vaccines, and Technologies PAGEREF _Toc18482 9 HYPERLINK l _Toc3521 2.
1.6 Service Delivery PAGEREF _Toc3521 10 HYPERLINK l _Toc19484 2.1.7 Evaluation, Accountability and Transparency PAGEREF _Toc19484 11 HYPERLINK l _Toc10399 Chapter three PAGEREF _Toc10399 12 HYPERLINK l _Toc15948 3.1 Universal Health Coverage in Botswana PAGEREF _Toc15948 12 HYPERLINK l _Toc26072 Chapter four PAGEREF _Toc26072 16 HYPERLINK l _Toc14062 4.1 Conclusion PAGEREF _Toc14062 16 HYPERLINK l _Toc10283 Reference PAGEREF _Toc10283 17Summery Universal Health Coverage(UHC) is defined as access to the quality health service with out the risk of financial hardships or without being pushed to extreme poverty due to catastrophic health expenditure. Even if, the system design to provide universal access to the quality health service, it also has significant effect in poverty reduction and increasing social stability. Beside the pressure from High prevalence of disease in Africa the other reason for investing in UHC is a moral one: it is not acceptable that some members of society should face death, disability, ill health or impoverishment for reasons that could be addressed at limited cost.
Accepting and integration of UHC in the national policy level is not enough, the national polices should be translated in to the ground. still Africa is facing challenge in despite of the national UHC police, with regard to health insurance and financial protection, mobilizing internal resource and quality health service delivery.There is no single fit model to achieving universal health coverage in Africa. All policies and strategies should consider each country local conditions. Even though , Africa is highly diversified continent most of problems are common for all countries. Africa should work on the basements of universal health coverage temple.
such as peace, good governance and health financing. In addition, Africa should also give attention on strengthening the pillars of UHC temple such as Health information, health human resource, medical products(health technologies) and service delivery. MethodsInternet review Literatures International and national policies GuidelinesSearch Engine Google Google scholar Chapter one1.
Introduce Universal Health Coverage(UHC) is the foundation for population stability in terms of health, sustained economic and social development. UHC was brought in to the table by Alma-Ata declaration before 30 years. With a central idea of ”Health for all”. which believed to produce better quality of life as well as prosperity and stability in the world (2). Universal health Coverage is a service package in the health sector that design to give a quality health service and financial protection to the entire population in a given country. The aim and objective of universal health coverage is financial risk protection, improved access to quality health services, and improved health outcomes(1).
In most country people prefer health one of their highest priorities, in another countries,they rate health before only economic concerns, such as unemployment, low wages and a high cost of living. Due to high health priority in the society, universal health coverage become a social and political concern(2). UHC is defined as access to the quality health service with out the risk of financial hardships or without they being pushed to extreme poverty due to catastrophic health expenditure. It is all about quality health service ,accessibility as well as financial risk protection. Even if, the system design to provide universal access to the quality health service, it also has significant effect in poverty reduction and increasing social stability(3). Because of the political and social nature of the system, the universal health coverage able to attract the attention of all UN state members.
Achieving UHC is an important objective for all countries to attain equability, accessibility, accountability, resilience and sustainability health structure. Health system strengthening is a means to progress towards UHC. A functioning UHC is organized around the people, institutions and resources that are mandated to improve, maintain or restore the health of a given population. 1.1 Global Initiative Towards Universal Health Coverage The World Health Assembly resolution 58.33/ 2005 says ”everyone should be able to access health services and not be subject to financial hardship in doing so”. Our world failed to achieve both promises of the resolution.Sustainable Development Goal(SDG) is the 2030 agenda by UN state members for governments and the international community to renew their commitment for improving social and political stability.
SDG has 17 goals with a defined priority areas of action. Of them Goal 3 is to ”ensure healthy lives and promote well-being for all at all ages”. UHC has special attention in goal 3 target 3.8 with a promising initiative for all people and communities having access to quality health services without risking financial hardship(4).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” (living on 1.90 USD (1) or less a day) because of health service payment. Over 800 million people (almost 12% of the world’s population) spent at least 10% of their household budgets to pay for health care(5). In 2015 as a part of Global sustainable development goal the UN state members agreed to renew their commitment to achieve UHC.In some setting income is not the only factor influencing service coverage but also illiteracy, location, migrants, ethnic minorities and indigenous people use services less than other population groups, even though their needs may be greater. The other side of the coin is that when people do use services, they often incur high, sometimes catastrophic costs in paying for their care. Only one in five people in the world has broad-based social security protection that also includes cover for lost wages in the event of illness, and more than half the world’s population lacks any type of formal social protection, according to the International Labour Organization (ILO), Only 5–10% of people are covered in sub-Saharan Africa and southern Asia, in Ethiopia only ;1% of the population has Health insurance, while in middle-income countries coverage rates range from 20% to 60%(1).Chapter two2.
Universal health coverage in Africa Africa is the world’s second largest and second most-populous HYPERLINK "https://en.wikipedia.org/wiki/Continent" o "Continent" continent . With 1.2 billion people as of 2016, it accounts for about 16% of the world’s HYPERLINK ;https://en.wikipedia.org/wiki/Human_population; o ;Human population; human population. Africa’s average population is the youngest among all the continents; the HYPERLINK "https://en.
wikipedia.org/wiki/Median" o "Median" median age in 2012 was 19.7, when the worldwide median age was 30 (6). The continent is still straggling to create sustainable and inclusive social and economic development. In Africa many countries are facing high levels of child mortality, maternal mortality, malnutrition, and most health systems are not able to deal effectively with epidemics and the growing burden of chronic diseases, such as diabetes. These challenges forced African leaders to renewed their commitments and to accelerate progress toward Universal Health Coverage (UHC) with initiative of everyone receives needed health services without financial hardship(8).Beside the pressure from High prevalence of disease in Africa the second reason for investing in UHC is a moral one: it is not acceptable that some members of society should face death, disability, ill health or impoverishment for reasons that could be addressed at limited cost.
However, UHC is also a good investment. Prevention of malnutrition and ill health is likely to have enormous benefits in terms of longer and more productive lives, educational productivity, and reducing health care cost. Effectively meeting demand for family planning will accelerate the fertility transition, which in turn will result in higher rates of economic growth and more rapid poverty reduction. And strong health and disease surveillance systems halt epidemics that take lives and disrupt economies.
The challenge in Africa is multi-dimensional require multi-directional solution (7).Achieving UHC in Africa is still promising concept but still need much more in terms of good governance, leadership and commitment.Most African countries have accepted UHC they also included as the part of their national sustainable development plane. If Africa able to achieve UHC by 2030 they could remove the pain of Africa from maternal and child death, outbreak, epidemics and poverty. Not only that, Africa could establish strong foundation for sustainable economic and social development. but, acceptance and integration UHC in the national police level is not enough, the national polices should translated in to the ground. still Africa is facing challenge in despite of the national UHC police, with regard to health insurance and financial protection, mobilizing internal resource and quality health service delivery.
There is no single rod that leads to the achievement of UHC in Africa, all policies and strategies should consider each country local condition. This UHC temple includes a set of strategic action to achieve UHC in Africa. Even though the great diversity in African, many are facing common challenges.
This temple has a proposed set of actions for countries and stakeholders involved in the UHC process. 2.1 Building UHC Temple in Africa2.1.
1 Peace, Good Governance and Leadership 1233170137160Peace and good governance is basementfor the temple of UHCPeace and good governance is basementfor the temple of UHCPeace and good governance is basement for the temple of UHC African leaders, freedom fighters,media, Civil societies should put first theircitizen thanthere politicalagenda and interest. 127952590170Peace, Good Governance and LeadershipPeace, Good Governance and Leadership Fig-1- Shows the the primary basement of the temple of Universal Health coverage Lack of peace results to the collapse of whole health system, and also create favourable condition for epidemics and outbreaks. this clearly shown in the case of south Sudan, Syria,Somalia and Libya.
Not only lack of peace, lack of good governance is responsible in many African countries for not functioning of the health system. Develop sustainable country capacity in law, policy, planning, leadership, and management. The health of population is dependent on different sectors out of the health system so improving inter-sectoral collaboration is a crucial strategy to protecting and maintaining population health.
Not only Create institution which takes the first step and leadership in the implementation UHC. Ensure easy information flow between all citizens and police makers, leaders in the about UHC. Making community to be the owner of health system in local, regional or national level. 2.1 Building UHC Temple in Africa2.1.2 Health Financial117475093345Health financing is basement for UHC templeHealth financing is basement for UHC templeGet rid of beggarmentality and aid dependency culture.
Looking for Internal source of income.Establish sustainable income source internally.Increase public 1410335220980Health Financing Health Financing and privatedomestic 122809093980Peace, good governance and leadership Peace, good governance and leadership resources. Fig-2- Shows the secondary basement of the temple of Universal Health coverage Not only generation of resource, reduce waste is very important, inappropriate wastage usually seen in Africa health care settings. Increase the efficiency of the both public and private health system, wise use of resource for better health out come. Increase domestic mobilization of resource through increasing government spending in the health system.
Use mobilized budgets and resources to reduce out of pocket payment and to make the services affordable to all citizens.External source of resources should be used as supplement budget for the health system. The sustainability of external source of budget is questionable, no country can have sustainable health system by depending on external source of budget.Support public private investment in the health sector and create competitive public and private health sector to benefits the large number of population(8,10) 2.1 Building UHC Temple in Africa2.1.3 Health Information115697092710Health Information is a pillar for Universal Health temple in Africa Health Information is a pillar for Universal Health temple in Africa Health informationis the firstPillar for Temple6134101090930Health Information Health Information of UHC. ensures that countries collect, analyze, disseminate, and use timely and High quality 143002039370Health financing Health financing health 1294130113665Peace, Good Governance and LeadershipPeace, Good Governance and Leadershipinformation.
Fig-3- Shows the first pillar of the temple of Universal Health coverage Priority objectives in health information are to ensures that countries collect, analyze, disseminate, and use timely and high quality health information. The primary objective health information are to Create a culture of evidence based informed decision making. Health policies, health plan, health budget, hospitals and health facilities should rely on demographic health survey, national health/society health survey, civil registration, vital statistics systems, district health information systems and clinical records.(8,9)2.
1 Building UHC Temple in Africa2.1.4 Human Resource for Health1221105252095Human Resource for Heath is the second pillar for UHC templeHuman Resource for Heath is the second pillar for UHC templeDevelop and implement modelsto address special 718185963295Health Information Health Information 1266190960755Human Resource for Health Human Resource for Health human resources for health needs.
Conceive and adapt effectivemodels for transformed education and 1511935127635Health Financing Health Financing maintenance 1389380215265Peace, Good Governance and leadershipPeace, Good Governance and leadershipof skills/competence. Fig-4- Shows the secondary pillar of the temple of Universal Health coverage Ensure countries to have a technically competent, well-deployed health workforce that provides essential services in accordance with standards in a timely, patient centred manner. Primary objectives in human resources for health should not be only to train or educate health professionals, but also Africa should design a system to hold professionals in the Country, to prevent brain drain(9,10).2.1 Building UHC Temple in Africa2.1.5 Medical products, Vaccines, and TechnologiesStrengthen supply 1215390172085Medical Product and technologies are third pillar to bullied the temple UHC In AfricaMedical Product and technologies are third pillar to bullied the temple UHC In Africachain components to ensure the 6019801384300Health Information Health Information uninterrupted 37528501135380Medical Product and TechnologiesMedical Product and Technologies10064751121410Human resource for health Human resource for health supply of quality-assured health commodities, including creating a supportive environment for commoditysecurity and 145224550800Health Financing Health Financing sustainable1294765169545Peace, Good Governance and leadership Peace, Good Governance and leadership supply chains.
Fig-5- Shows the third pillar of the temple of Universal Health coverage Ensures that people have sustained access to and make appropriate use of essential medical products that are safe, effective, and assured quality. Strengthen supply chain components (forecasting, supply planning, procurement, storage, distribution, inventory control and logistics information systems, laboratory harmonization, and waste management) to ensure the uninterrupted supply of quality-assured health commodities, including creating a supportive environment for commodity security and sustainable supply chains. Strengthen medicines regulatory capacity to protect the public health from counterfeit and substandard products and pharmaceutical sector governance to promote transparency and accountability through appropriate laws, regulations, policies, and standard operating procedures.Increase and enhance human and institutional capacity to manage pharmaceutical systems and services, including promoting evidence-based use of medications, assuring therapeutic efficacy, protecting patient safety, and slowing the emergence and spread of antimicrobial resistance(10).2.1 Building UHC Temple in Africa2.1.
6 Service Delivery 1162050252095Service Delivery as forth pillar to bullied the temple UHC in AfricaService Delivery as forth pillar to bullied the temple UHC in Africa Scale up quality,coordinated 36048951195705 Service Delivery Service Delivery 31121351202055Medical Product and Technologies Medical Product and Technologies 9493251198880 Human resource for health Human resource for health 4978401196340Health Information Health Information delivery of essential, evidence-based health services. Develop and implement Cost effective 1411605160020Heath Financing Heath Financing essential health 1336040251460Peace, Good Governance and leadership Peace, Good Governance and leadership services packages. Fig-6- Shows the fourth pillar of the temple of Universal Health coverageensures access to effective, safe, and high-quality public and private sector services by those who need them, when and where they are needed, with maximum efficiency and patient choice. Regular Scale up for quality and coordinated delivery of essential, evidence-based services. Develop and implement cost-effective essential health services packages(9,10).2.1 Building UHC Temple in Africa2.1.
7 Evaluation, Accountability and Transparency 1142365108585Universal Health CoverageUniversal Health Coverage1132840101600Use evaluation, 10979151102995Human Resource for HealthHuman Resource for Healthaccountability369252591440AccountabilityAnd TransparencyAccountabilityAnd Transparencytransparency39471601039495Service deliveryService delivery5016501029970Health InformationHealth Information9709151035685Health InformationHealth Information3272155168275Accountability and TransparencyAccountability and Transparency34575751032510Medical Product and TechnologiesMedical Product and Technologies10896601036955Human Resource for HealthHuman Resource for Healthtools as the door and the windows 267208066675EvaluationIn termsOf qualityefficiencyequity EvaluationIn termsOf qualityefficiencyequity to regulate2408555139700EvaluationIn terms of QualityEfficiencyEquityEvaluationIn terms of QualityEfficiencyEquityand monitor the whole Structure of the templeof UHC. 1377950260350Health FinancingHealth Financing1261745104140Peace, Good Governance and LeadershipPeace, Good Governance and LeadershipFig-7- Shows the third door and the windows of the temple of Universal Health coverageRegular monitoring and evaluation to the basement and the pillars of UHC temple. Ensure access to data and information on UHC, as part of societal dialogue and participatory processes. Develop sustainable country capacity in transparency and accountability in law, policy, planning, leadership, and management(10). Chapter three3.
1 Universal Health Coverage in BotswanaThe total population of Botswana was 2,250,000 by the year 2016, in the same year gross national income per population was $15 ranks the five in Africa. Life expectancy at birth by the year 2016 was 66, the African average was 61.2. Total expenditure on health was 5.
4 % but WHO recommend Africans should spend 15% of their budget on health(11,12,13).Botswana categorize three cause of population health problem. One infectious disease, responsible for the cause of death to all age group of population most importantly HIV/AIDS.
Two, maternal mortality rate both under five and infant mortality. Diarrhoea and pneumonia are among the top listed cause. Three, non communicable disease(14).-98361512065Fig-8 …. Cause of mortality in Botswana Source; Botswana Health and HIV/AIDS Public Expenditure Review June 15, 2016 Health, Beside moral initiative, Botswana government is under pressure from high prevalence of HIV, infectious diseases, maternal mortality, Chilled mortality and high health spending. The government of Botswana establish different financial strategies and policy initiatives to improve the efficiency and health outcome.
The central idea behind Botswana policy initiatives is to strength universal health coverage through adequacy, universality, cost effectiveness, affordability, and focus on vulnerable groups. Health policy initiative in Botswana are:- resource mobilization, increase efficiency, catalyse public/private partnership and improve health insurance(15,16).Resource MobilizationBotswana begin to mobilize funding by calculating budget gap and resource need for health. through searching fiscal space for health and increasing government expenditure to health.
For example, until 2008, % of GDP allocated to health was only 5.4 compared to south Africa 8.9% and Namibia 7.7%. Budget gap and resource calculation includes all sector needs such as : primary health care, hospital care, HIV/AIDS response, and policy, planning, monitoring and evaluation, and regulation(15,16). Catalyse public and private partnershipTransform the Ministry of Health (MoH) from being a pass-through of annual budgets to a contractor by strengthening contracting services and paying for results. Develop a system that gives people the freedom to obtain services from public and private providers. MoH and Mass aid Scheme (MAS) begin to work in partnership to pay for services.
The MoH pays private primary healthcare providers and hospitals to expand coverage and services to the population(15,16).Improve Health insuranceRedefine the role of commercial MAS to supplement essential health service package (EHSP). Create a national insurance fund that pools contributions from multiple sources of financing. Subsidize MAS enrolment to expand coverage to the entire population. MAS to develop affordable insurance plans to cover EHSP(15,16).Increase Efficiency The Botswana MoH begin to asses health system performance in terms of health outcome, service coverage and financial protection to find the gap in efficiency. Regarding health outcome high prevalence of HIV/AIDS, malaria, TB are still the three big infectious diseases in Botswana. Maternal mortality, chilled mortality and infant mortality are the top listed cause of death in Botswana.
Regarding service coverage 94.1% live around 8km reduce of the health facilities the average upper middle income country was 95.4. there is no data on catastrophic health expenditure.To enhance the efficiency the MoH renew the drug policy, begin to use pool procurement and begin to replace brand by generic drugs.
Increase efficiency and quality by encouraging competition between and among public and private providers. Create a National Health Technology Assessment Unit to update the EHSP on a regular basis, make recommendations on essential medicines, promote the use of the most cost-effective interventions and issue clinical guidelines. Improve managerial practices and standard operational procedures at all levels to reduce waste and improve operations(15,16). All Botswana citizens are entitled to free Antiretroviral therapy (ART) and around 66 percent of the HIV-infected population (248,000 people) was receiving ART in 2015. which was a great achievement indeed in reduction in HIV/AIDS related death(15,16).3252470126365-43815142240Fig-8- Percent Cause of death in Botswana Fig-9- Trend Crude mortality rate Due to those significance policy Initiative, total death in Botswana begin to reduced from 23,600 in 2002 to 13,200 in 2013.
In terms of crude mortality rate, reduced from 1.24 to 0.65 percent in the same respective year. Regarding Cause of death in 2002, 46.6 percent of death in Botswana is HIV/AIDS related death but due to remarkable achievement in improving access to HIV treatment, HIV/AIDS related death in Botswana reduced to 33.3 percent in 2013. Chapter four 4.
1 Conclusion The 21st century, challenges of universal health coverage is to provide quality health service for all in limited resource setting. There is no single fit model to achieving universal health coverage in Africa. All policies and strategies should consider each country local conditions. Even though , Africa is highly diversified continent most of problems are common for all countries.
Africa should work on the basements of universal health coverage such as peace, good governance and health financing. In addition, Africa should also give attention on strengthening the pillars of UHC temple such as Health information, health human resource, medical products(health technologies) and service delivery. Reference World Health Organization (November 22, 2010). HYPERLINK "http://www.who.int/whr/2010/en/" "The world health report: health systems financing: the path to universal coverage". Geneva: World Health Organization.
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org/mediccreview/index.php?issue=17" Achieving Universal Health Care (July 2011). MEDICC Review: International Journal of Cuban Health and Medicine 13 (3). Theme issue: authors from 19 countries on dimensions of the challenges of providing universal access to health care. HYPERLINK "http://www.
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