United Nations Universal Health Coverage Day: Engaging Stakeholders in Ghana on Achieving Health for All

12 December, 2016 is Universal Health Coverage Day, marking the anniversary of the landmark 2012 United Nations resolution calling for countries to provide affordable, quality healthcare for everyone, everywhere, the first such resolution ever to be passed unanimously.

Vicky Okine, Executive Director for the Alliance for Reproductive Health Rights, which leads a coalition of civil society organizations in Ghana in partnership with PAI, advocat­­ing for primary health care as a foundational pillar of universal health coverage, explores the challenges still facing the West African nation in securing quality, affordable health care for all its citizens.

Today is the anniversary of the first unanimous United Nations resolution calling on all countries to provide every person with affordable, quality health care as a human right. Universal health coverage — a target under the UN’s sustainable development goals — is critical to making long-term progress in ensuring health, wellbeing, and prosperity for all. The first step on the road to achieving universal health coverage is through securing improvements in primary health care.­

Quality primary health care services form the solid foundations on which the overall health, wellbeing and prosperity of entire populations depend. A solid primary health care system will provide a basic level of service, from prenatal and pediatric care, to immunization and the prevention and treatment of common conditions. It will co-ordinate and integrate such care regardless of where it is delivered, and seek to ensure that it is available to all.

Countries with well-established, high performing primary health care systems will be better equipped to combat infectious and non-communicable diseases, such as HIV/AIDS, malaria and hypertension, while those with weaker systems will struggle. We witnessed this as recently as 2014, when an outbreak of the deadly Ebola virus in West Africa particularly ravaged countries with poorly developed primary health care systems.

The Alliance for Reproductive Health Rights (ARHR) is a proud member the Primary Health Care Global Strategy Group (PHCGSG) convened by PAI. In addition to our work in promoting a rights-based approach to reproductive, maternal, newborn and adolescent health, ARHR works within this consortium of civil society organizations to engage with Ghana’s government and policymakers to advance primary health care.

Ghana’s health care system has been described as the most successful on the African continent. Despite this resounding approbation, the Ghanaian system is not without its challenges.

A national health insurance scheme (NHIS) was introduced in 2003, replacing an iniquitous ‘cash and carry’ system where services were only provided after payment had been made, to the detriment of Ghana’s poorer citizens. In principle, every Ghanaian citizen pays for the NHIS through their taxes, but many of the country’s poorest remain excluded. Sixty-four percent of wealthier Ghanaians are registered under the NHIS, compared with just 29 percent of the poorest. Many people are not interested in registering because some essential services are not covered by NHIS, including family planning services.

Things may be changing, however, thanks to advocacy from ARHR and its partners in the PHCGSG. The consortium has been vocal about the need for the inclusion of family planning into the national insurance package.

The national adolescent reproductive health policy in Ghana will be launched soon. The previous policy didn’t comprehensively address issues facing young people, including where they can go to get information. Services are primarily available within physical health facilities, whereas young people — who are often shy, usually depend on peers to access information — and must face any repercussions of receiving incorrect advice. The updated policy will incorporate emerging trends, including the use of social media to communicate to young people.

Women are also particularly vulnerable. Many lack the economic means to be able to access health services and because Ghana operates under a more patriarchal culture, women are frequently not allowed to articulate their needs. Because of their vulnerable status in society, they cannot really demand better service, or insist that their voices are heard.

I believe that it’s important to empower communities and individuals to realize their full potential. People are sometimes unaware of their rights, or unable to articulate them, and because of that, the government may take them for granted, or ‘second guess’ their needs and priorities. Yet this of itself can be challenging because many individuals aren’t educated enough to identify and articulate their own needs. Patients will seek treatment when a health problem arises, for example, but don’t necessarily have the tools or knowledge of how to prevent these health challenges occurring in the first place, which inevitably leads to increasing rates of noncommunicable diseases, such as diabetes and malaria. This is where the PHCGSG, which is comprised of a variety of civil society organizations (CSOs) with specialized knowledge, can make a contribution. The Government of Ghana has come to realize that CSOs can play a key role in improving health by articulating the needs of the community and maintaining accountability.

Those key challenges in health relate to access, human resources for health care and financial resources. Civil society is crucial to documenting gaps and raising awareness among stakeholders of the need to invest in and strengthen primary health care systems as a means of achieving universal health coverage.

In partnership with our colleagues in the PHCGSG, ARHR will continue to engage policymakers around moving Ghana toward a health system with primary health care at its center, whilst striving to build the capacity of communities to generate resources for their own development. People are becoming more aware, and that gives me real hope for Ghana’s future.