Keynote address at a high-level side event on universal health coverage in Africa at TICAD
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, honourable ministers, distinguished officials from UN agencies, the Global Fund, the World Bank, and the African Development Bank, ladies and gentlemen, I thank the governments of Kenya and Japan for spearheading this event. I am honoured to speak in the presence of so many heads of state and government here in Africa.
The large number of co-hosts indicates the broad base of international support as Africa moves towards greater health equity, strengthened health security, and better health outcomes.
The Ebola outbreak in West Africa brought the world face-to-face with the consequences of failing to invest in the community and resilient health systems.
No outbreak can be quickly contained if weak health systems and poor surveillance keep cases invisible for months on end.
Well-functioning health systems that cover entire populations are now regarded as the first line of defence against the threat from emerging and re-emerging diseases.
Apart from strengthened health security, Africa has much to gain from its commitment to universal health coverage.
For decades, the biggest barriers to better health in Africa have been weak health systems and inadequate human and financial resources. A commitment to UHC means a commitment to address these barriers.
UHC also addresses a third barrier to progress: dire poverty, including poverty caused by catastrophic spending on health care.
A commitment to UHC, backed by country-specific plans for implementation gives African countries a huge opportunity to leap ahead.
In 2014, African countries spent about $126 billion of domestic funding for health. Between now and 2030, domestic resources will be by far the main source of funding for UHC.
WHO estimates that African countries can mobilize an additional $65 to $115 billion in domestic funding annually over the next ten years.
Nobel laureate Amartya Sen has described UHC as “an affordable dream”. I agree. UHC is affordable if properly managed.
As a way of organizing health services, it promotes a comprehensive and coherent approach to health which emphasizes people-centred quality care throughout the life course, stresses prevention as well as cure, and moves away from a focus on individual diseases.
Doing so opens numerous opportunities to reduce waste and inefficiency. For example, studies show considerable savings when supply chains established to deliver drugs for HIV are used to deliver multiple other products.
I have three pieces of advice.
First, understand that UHC is a direction for a journey, not a destination. Any country, at any income level, that really wants to can move towards universal coverage.
African countries have already produced a rich menu of policy options, as set out in your Framework for Action.
Second, use the power of robust data to shape equitable policies in line with your national context.
For example, Kenya used the results from a survey of public expenditure to launch its innovative Health Sector Services Fund that provides direct cash transfers to primary health care facilities.
Third, if UHC is to work as both a poverty-reduction strategy and a boost to health security, countries need to ensure that reforms reach health systems at the district level.
These systems are the lifeline for impoverished communities, and are best placed to engage them in health promotion, prevention, and the delivery of services that match perceived needs.
They are also the frontline for the surveillance and information systems needed to detect and contain outbreaks early.
As I conclude, let me commend you for your commitment to this grand but affordable dream.