Universal Health Coverage is Possible with Community Health
By Dr. Diana Nambatya Nsubuga, UHC Co-Chair, Africa, and Deputy Country Director Community Health Strengthening
With the upcoming UN General Assembly, I join my colleagues around the world in raising our collective voice to share the stories of the millions of people still waiting for primary health care to reach their community. We want to remind the world that #HealthForAll is imperative for the world we want and the world we want is one with universal health coverage (UHC). This cannot be achieved without smart investments in financially sustainable community health programs that are integrated in national health systems.
Recently, strong economic growth has helped reduce poverty to 43 percent of the African population. Yet, as Africa’s population expands to an estimated 2.5 billion by 2050, the region faces a critical challenge in creating the foundation for long-term, robust growth. Many countries still contend with high levels of child and maternal mortality, malnutrition is far too common, and most health systems are not able to deal effectively with epidemics and the growing burden of chronic, noncommunicable diseases. Millions of Africans must travel far, arduous distances to access health facilities and often fall into poverty due to high out-of-pocket health payments when accessing basic health care services.
This economic and population growth, combined with an evolving disease burden and inaccessibility, will continue to increase demand for reliable health services, further placing pressure on the existing health systems, and ultimately threatening the progress toward achieving UHC. But we believe there is a solution. Estimates indicate that 90% of all health needs can be met at the primary-care level, highlighting a crucial need for robust, effective investment in primary health care (PHC) services that extend to the community level.
This means investment in effective community health systems, given community health provides a necessary link between the health facility and the last mile of primary health care. Community health programs provide a high-impact, low-cost solution to the health systems challenges faced in low- and middle-income communities, alleviating pressure on resource-constricted health facilities and reducing inequities in access to care. Community health workers (CHWs) — the agents of a strong community health system — act as the first line of defense, relieving the burden on hospitals and facilities by providing primary health care services to their neighbors. Because CHWs live within the communities in which they serve, they can identify and reach more people before their health conditions become life-threatening.
Research estimates that 18 million health workers are required — primarily in low- and middle-income countries — to achieve UHC and the health-related SDGs. Investments in high-quality community health programs, including the training and remuneration of CHWs — are integral to help fill this gap and scale up access to primary health care and UHC.
Accelerating progress toward UHC in Africa is still within reach, but it requires political leadership and a clear strategic vision. Countries that achieve their UHC targets by 2030 could eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies, reduce financial hardship linked to illness, and strengthen the foundations for long-term economic growth. We believe investing in community health systems can jumpstart this.
With the United Nations High-Level Meeting on UHC (HLM-UHC) on September 23, this is an opportunity for UHC advocates to mobilize political attention at both the global and national levels. The resulting Political Declaration on UHC will form the basis for global efforts to provide universal access to affordable and quality health care services and set milestones toward achieving UHC by 2030. Living Goods calls for the prioritization of quality community health programs that are financially sustainable and integrated in country health systems at the HLM-UHC. We need all stakeholders on board to ensure community health programs are prioritized at the HLM-UHC.
