Universal Health Coverage (UHC)

Universal Health Coverage

Our Purpose

We believe that health is a basic human right. Everything we do ensures lasting health change for all.

The Challenge

Despite the global momentum on UHC, half the world’s population still lacks access to essential health services. Close to 12% (800 million people) of the world’s population spend more than 10 per cent of their household budget on health care leading to almost 100 million people being pushed into extreme poverty each year because of out-of-pocket health expenses (WHO 2017). Africa faces a grimmer scenario. The region, which is home to 11 per cent of the world’s population, accounts for 24 per cent of the global disease burden and accounts for less than one per cent of global health expenditure. The region’s poor health status is mirrored by perennial crises in health financing and human resources for health. Most African countries remain ill-equipped to address their health problems adequately. Low per capita income, limited capacity for domestic revenue mobilisation, and pervasive health system bottlenecks complicate the ability of governments to respond to the health challenges (Africa Union, 2016).

The Opportunity

Good health is essential for the economic and social development of all nations. Access to quality health services is crucial for maintaining and improving health. At the same time, people need to be protected from being pushed into poverty because of the cost of health care. In recognition of these imperatives, the global momentum for Universal Health Coverage (UHC) has greatly increased, with the 2030 Agenda for Sustainable Development setting it as a central tenet for improving the health and well-being for all people and includes delivery of disease prevention, health promotion, treatment and rehabilitation, and palliative care, while ensuring that individuals are not driven into poverty due to the cost of health care.

To deliver on UHC, opportunities exist to ensure: (i) Equity in access to health services – everyone who needs services gets them; (ii) the quality of health services are good enough to improve the health of those receiving services; (iii) people are protected against financial-risk, ensuring that the cost of using services does not put people at risk of financial harm. (iv) accountability to translate commitments relating to access, quality, and financial protection into action through transparency and citizen participation.

Our Theory of Change

Amref Health Africa focuses on creating equitable access, as the most important principle in UHC – ensuring that socially disadvantaged and marginalised populations have access to health care – and fully realise their right to health. Amref works with governments and development partners to operationalise mechanisms for reaching those left behind. Universal Health Coverage means providing effective coverage for the entire population (“breadth”), for all necessary care (“depth”), at affordable costs and under conditions that are not burdensome, as well as offering particular benefits to address the differential needs of the least well-off (“height”)

To ensure that no one is left behind in the UHC journey, Amref continues to deploy last mile social innovations, especially new outreach models, to reach the most vulnerable communities with primary health care services. Amref is a champion of Primary Health Care (PHC) and believes that appropriate targeting and design of interventions will address the health needs of marginalised and vulnerable populations. As a core part of the PHC approach, CHWs contribute to bridging the gap between communities and the formal health system, playing a key role in community engagement, referral, health promotion and disease prevention at the community level.

The success and value of UHC depend on the ability to provide quality services to all people irrespective of social-economic differences with no risk for catastrophic health expenditure. It is therefore important to place quality and continuity of care at the centre of country, regional and global action, to progress towards effective UHC. For this to happen, health systems need to be complete with fully functional health system blocks, including human resources for health and leadership, management and governance. Our experience across Africa has demonstrated that LMG is a core driver of health system effectiveness.

In support of the delivery of quality health services, Amref supports the training of mid-level and community health workers through in-service, pre-service and continuing professional development. We do this through blended learning approaches – traditional and ICT-propelled education and training methods, e.g. eLearning and mLearning through the Amref’s Institute of Capacity Development and the Amref International University. Using these approaches, we train over 100,000 health and health-related workers every year on different diseases as well as Leadership Management and Governance programmes for Health Systems Strengthening, including the delivery of quality health services. Amref is in the process of developing a UHC curriculum targeting senior-level managers.

We have successfully implemented data-informed quality improvement approaches in health care settings. These include Continuous Quality Improvement (CQI) using the Amref Health Africa CQI toolkit, Partnership Defined Quality at the community level, and Kenya’s Quality Model for Health applied in health facility settings.

Health Financing and Financial Protection: Amref has been at the forefront in advocating for increased investments in health through budget advocacy and tracking, blended financing, financial protection of citizens and strengthening strategic purchasing.

In Kenya, Amref has employed budget advocacy approach to increase the allocation of resources to health dockets at national and devolved government levels. We have successfully built the capacity of devolved governments on planning, prioritising and budgeting to increase the allocation of funds for health service delivery. With the increased resources, counties can finance medical commodities in time, support community health workers with stipends, pay health worker allowances, thus averting strikes, strengthen emergency response, and drafting of county UHC frameworks.

Amref advocates for and supports a tax-based or insurance-based model of health financing for financial protection and we have partnered with the national Ministry of Health in piloting and rolling out UHC. We have worked with the National Hospital Insurance Fund to accelerate the uptake of the national social insurance health benefits package by under-served communities through a digital health platform that links CHWs and the community with health insurance – making the process of household registration efficient and user-friendly.

In collaboration with Results for Development (R4D), Amref is implementing the Strategic Purchasing Africa Resource Centre (SPARC) to build capacity enabling countries to undertake Strategic Purchasing.

In support of a blended financing mechanism, Amref has just concluded a feasibility study on Private-Public Partnership (PPP) for PHC in Makueni County to unlock new finances for the health sector from the private sector which is ready for scale-up nationally.

We are engaged in social accountability by ensuring that citizens and providers are educated about their right to health, mechanisms are employed for their voices to be heard, and tools are utilised to hold duty-bearers accountable for policy and programme implementation and results. Through a consultative process, Amref has developed a robust Social Accountability Framework to catalyse progress towards UHC in Kenya and Africa at large by working with partners to enhance citizens’ voices to improve government and health care policies, resources, and practices.

Our Ask

Catalysing UHC in Kenya will require strengthening health systems, robust financing structures and models, reduction of out of pocket expenditures to near zero, and the availability, accessibility, and capacity of health workers to deliver quality people-centred integrated care.

We seek to establish shared value partnerships with Philanthropic Organisations, Governments, private sector entities, and Development Finance Institutions (DFIs) in investing in quality primary health care, good governance, sound procurement and supply systems, health technologies and well-functioning health information systems.