Dr Owen Kaluwa
“We don’t go to the hospital,” Adwoa says.
“Things are very expensive these days so if it is not serious we stay home,” she adds.
Adwoa is a petty trader and a single mother of three. As a school dropout and a widow, she relies solely on the income she generates from her petty trading to cater for her children, including their education.
For her, health is not on the priority list; as money to even buy food for her children is sometimes a challenge
“It is not easy my sister, when you have to do everything on your own sometimes, health is the last thing on my mind. When they get sick, I boil herbs for them and by God’s grace they get well,” Adwoa states.
Although Adwoa lives in the city, she is unable to access healthcare because of the cost involved.
The government of Ghana, identifying the plight of the marginalised in accessing healthcare, initiated the National Health Insurance Policy, a pro-poor policy aimed at removing the financial burden of patients in accessing healthcare in the country, thereby, ensuring Universal Health Coverage (UHC).
World Health Day
The WHO constitution has health as a human right and the attainment of the highest possible level of health by all as one of its main objectives.
‘Health For All’ has, therefore, been the guiding vision for the global organisation more than seven decades. It’s also the motivation behind the current organisation-wide drive to support countries in moving towards Universal Health Coverage (UHC).
For instance, the theme for this year’s World Health Day is ‘Universal Health Coverage: Everyone, Everywhere’ and the slogan is ‘Health For All’.
World Health Organisation (WHO) country representative for Ghana, Dr Owen Kaluwa, in commemoration of the World Health Day in Accra, Ghana says UHC focuses on ensuring that everyone everywhere can access essential quality health services without facing financial hardship.
“Health For All is to promote Universal Health Coverage (UHC) by 2030 with the aim to support policymakers, civil society organisations, individuals and media in the journey to bring universal health coverage to your country. Something all countries committed to when they agreed the Sustainable Development Goals (SDGs) in 2015,” he adds.
Universal Health Coverage (UHC)
Dr Kaluwa says UHC means all individuals and communities receive the health services they need without including the full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation and palliative care.
“UHC enables everyone to access the services that address the most important causes of disease and death, and ensures that the quality of those services is good enough to improve the health of people who receive them. This is the vision that we should all commit to,” he states.
He mentions that there have been major advances in health and health technology, including life-saving medicines for diseases such as HIV/AIDS, tuberculosis, malaria, hypertension and diabetes which have widened access to healthcare.
In the African region, WHO indicators show that health outcomes have been improved through strategies such as distributing insecticide-treated nets to prevent malaria and vaccinating against the human papilloma virus which causes cervical cancer.
Access to treatment and essential services has also improved. For the first time, available health data shows that more than half of all people living with HIV in Africa (14 million) have access to life-saving HIV treatment.
Between 2010 and 2016, new cases of malaria dropped by 20 percent and there were 37 percent fewer deaths due to malaria. Moreover, in 2016, the risk of developing, pneumonia and meningitis reduced for nearly two thirds of children on the continent because they were vaccinated, compared to only three percent in 2010.
“In 2012, Africa accounted for over 50 percent of polio cases globally. The good news is that since August 2016, the region has not reported a case of wild poliovirus. Indeed, progress is being made on a number of fronts,” Dr Kaluwa adds.
The WHO country representative, however, points out that much more needs to be done to curb the increase in non-communicable diseases, address public health emergencies, including new threats such as SARS, influenza A H5N1 and tackle epidemics like Ebola and cholera.
“There is also a need to address the ever-growing challenge of anti-microbial resistance and substandard and falsified medicines,” he explains.
Dr Kaluwa says several countries in the region, including Burkina Faso, Burundi, Ghana, Liberia, Senegal and Uganda, have demonstrated that removing user fees systematically increases utilisation rates of health services.
Ghana’s Situation
Speaking at an event to mark the World Health Day, Health Minister Kwaku Agyeman-Manu shares the same sentiments, saying quality and affordable healthcare is the foundation for individuals to lead productive and fulfilling lives and for countries to have strong economies.
He says Ghana’s National Health Insurance Scheme (NHIS) is a pro-poor policy and offers a generous benefit package to its members, including exemption to the extreme poor in the country.
“Yet many poor people find it difficult to pay registration fees as well as the premiums. Although the scheme is designed to cater for the very poor of society, it has difficulties determining the socio-economic status of applicants: Fixing flat-rate rather than income-related premiums, also burden poorer members excessively,” he explains.
Adwoa reveals that she once had the NHIS cards when she took advantage of a health outreach by a church, which included free NHIS registration.
“I could not renew the cards after they expired and you know the reason; money,” she says.
Adwoa adds that until healthcare is made truly free for people like her and other women, they will not be able to access it.
Mr Agyeman-Manu indicates that for the country to move towards Universal Health Coverage, the country needs to find more money to invest into the NHIS. As the relative contributions of premiums is small, tax-based funding is the obvious source.
“However, increasing the fiscal space to fund the NHIS requires economic growth and improved tax collection Universal Health Coverage, however, cannot be achieved in Ghana without revamping and strengthening the health system.
Essentially, this means that everyone must have access to affordable quality health services – well equipped health infrastructure with essential equipment, medicine and drugs and trained and skilled human resource for health,” he said.
Way Forward
The minister says the attainment of UHC is a huge task and a long journey, but believes that if partners work together the country can attain its targets.
One of such partnerships is the ‘Health For All’ programme that was launched on World Health Day with the support from the World Bank.
When implemented, the initiative will ensure Ghana’s Community Health Planning Services (CHPS) strategy which provides a good example for community level focus and delivering health services at the community to be offered free of charge.
The programme will equip CHPS compounds in the country to provide quality basic healthcare services at the community level at no cost to patients.
“This, we believe, will go a long way to reduce the burden of diseases on the Ghanaian population, thereby, strengthening the labour force and increasing productivity,” he adds.
Pull Out
What UHC Is Not
UHC does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis.
UHC is not only about ensuring a minimum package of health services, but also about ensuring a progressive expansion of coverage of health services and financial protection as more resources become available.
UHC is not only about medical treatment for individuals, but also includes services for whole populations such as public health campaigns – for example adding fluoride to water or controlling the breeding grounds of mosquitoes that carry viruses that can cause disease.
UHC is not just about healthcare and financing the health system of a country. It encompasses all components of the health system: systems and healthcare providers that deliver health services to people, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms and governance and legislation.
By Jamila Akweley Okertchiri