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Universal Health Coverage: Local action driving universal achievements

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The world has never been as aligned on a common global health priority as it is now on universal health coverage. It is a global imperative for cohesive societies and economic prosperity. A consensus has existed since 1948 that health is a human right, and the call for health for all has been a lingering voice since 1978 at Alma-Ata. But there has never been such high advocacy as there is today with the current call for universal health coverage with access to essential services for all without financial hardship.

The United Nations High Level Meeting on 23 September 2019 in New York may be the climax of this building advocacy. Despite this celebratory moment, there remains a real fear that the political endorsements, high fives, dinners and numerous side events, will bring little change for half of the world’s population, living in Malawi, Vietnam, Somalia and other countries. This includes large numbers of people living in developed countries such as the United States who still do not have full coverage for essential health services.

As the world converges in New York this September, many issues will need to be prioritised. The UHC2030 movement, through its various multi stakeholder constituencies and wide-ranging consultations, has identified six key areas of focus. They start with political leadership beyond health and commitment to health as a social contract. Health is the foundation for people, communities and economies to reach their full potential – and the achievement of universal health coverage is primarily the responsibility of governments.

Governments ensure that people’s health is a social contract, noting that achieving universal health coverage is essential for inclusive development, prosperity and fairness. It requires political decisions that go beyond the health sector.

Second, half the world’s population is left behind. That includes the poor, migrants, criminalised populations and women. Health is enshrined as a fundamental right of every human being. Universal health coverage is key to reducing poverty and promoting equity and social cohesion.

Local action driving universal achievements

Extending geographic coverage and reaching the most marginalised and hard-to-reach populations are essential to achieving positive health outcomes. For real action in all communities, governments must commit to report disaggregated data for the official statistics compiled on the Sustainable Development Goals in order to capture the full spectrum of the equity dimensions of universal health coverage.

The third priority is to ensure that governments create a strong, enabling, regulatory and legal environment that responds to people’s needs and builds institutional capacity, so the rights of people and their needs are met. There is no debating the fact that governments bear this primary duty under the International Covenant on Economic, Social and Cultural Rights.

The fourth call is to uphold the quality of care by building health systems that people and communities trust. That starts with primary health care as the backbone of universal health coverage. It is best achieved through creating confidence in public health systems that respond to people’s needs and deliver desired outcomes.Where private health services are required, leadership should come from the public sector.

The fifth call is for leadership through public financing and efficiency by investing more and investing better through sustainable public financing and by harmonising health investments from all players including development assistance and the private sector. Governments must adopt ambitious investment goals for universal health coverage and make progress in mobilising domestic pooled funding towards existing targets, such as 5% of gross domestic product or the African Union’s Abuja Declaration of 15% of government expenditure. This funding should be equitable and driven by the need to reduce impoverishing and catastrophic out-of-pocket expenditures for communities.

Furthermore, development assistance for health should reduce fragmentation and strengthen national capacities for health financing.

Finally, and in line with SDG 17 on the need for partnerships – and in recognition of the fact that health can only be achieved by a whole-of-society approach – countries should take active steps to engage non-state actors more meaningfully. In providing clear direction from the public sector, civil society and the private sector, they too can shape the universal health coverage agenda.

As in many other sectors, there is no one-size-fits-all answer. Solutions for each country must be tailored to that country’s particular context and population needs. The international community and global health partners should unite to support all countries to build a healthier world. The UN High Level Meeting in September must therefore reach high enough to mobilise political leadership but local enough to drive meaningful country action.

Githinji Gitahi joined Amref Health Africa as the group chief executive officer in June 2015. He is also a member of the Private Sector Advisory Board of Africa CDC, the Global Health Investment Advisory Board, and of the World Health Organization’s Community Health Worker Hub. Gitahi is co-chair of the UHC2030 Steering Committee, a global World Bank and World Health Organization initiative for universal health coverage. Gitahi has a doctor of medicine degree from the University of Nairobi and a master’s in business administration from United States International University.

Health

Dream Becoming A Reality

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The residents of Kyukuni Village, Voo Kyamatu Ward, Kitui County had challenges in accessing water before the intervention of the Amref Health Africa Kitui WASH Project. Residents would trek for over 15km in search of water, a situation that not only affected the time women spent doing other economic activities, but also affected school enrolment and attendance among school going children.

According to the Project Officer George Wambua, there were shallow aquifers which were an alternative source of water, but the residents believed that water from this source would only be enough for household use and nothing else. This was a long standing belief that they held, and changing it was an uphill task.

During a baseline survey that was carried out in 1998, water was ranked first on the priority list of needs among communities. For the residents of Kyukuni Village, water was a priority but they did not realize how it could help to change their economic status. “Changing their mind-set to make them see how water could improve their lives economically was a challenging task. However, with continued follow-ups and interactions with the community, we were able to change the community’s way of doing things,”said Mr Wambua.

In trying to make a case for using water to improve the community’s economic status, the project started by developing a small farm around the Miembeni giant well situated in Zombe/ Mwitika Ward. The well serves a group of 12 families who decided to change their traditional way of doing things. They decided to extend water use from domestic to other economic activities including horticulture farming and poultry keeping.

Sukuma wiki farming

According to Mr Mutua, one of the beneficiaries of the project, a number of giant wells were commissioned along the Thua River through the  support of  Amref, but only a  few of the groups seriously engaged in intensive farming.

“You would find a group of 15 households doing small scale farming that was not enough to support the whole group, but yet the well had sufficient recharge of about 10m3.

This means they only utilised 30% of the water in the well leaving 70% not utilised”, said Mr Mutua. He added that when his group realized that they were sleeping on gold about two years ago, they started serious farming activities around their water points. The group now owns a two-acre piece of land that can be utilized freely by the group.

Kitui East has been hard hit by the regular occurrence of drought due to erratic rainfall. For the last 10 years, the rainfall pattern has been unpredictable. The rainfall onset has been delayed every year, and when it has rained, rainfall has also not been adequate. The only remaining option is to use water from the well to grow crops that can feed their families and have some left overs to sell for economic sustainability. This is what Mr Mutua the chairperson, encouraged his group to do.

“We started our farming in a small way by cultivating very basic crops just enough to feed our families. Little did we know it was our turning point as a group,” said Mr Mutua.

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Mr Mutua added that they upgraded their activities by growing cash crops like tomatoes, onions, water melons and carrots. The first group was successful and made good profit. On sharing the profit among the 15 households’ after all necessary deductions, each was able to get Kshs 5,000. This enabled members have cash to do other things like paying school fees and other bills. The community members had longed for.

Poultry farming

“God is great, our dream has come true,” said one of the group members.

Additional activities carried out using water from the well include poultry farming. This is another project that has had multiple benefits to the family. The groups now have eggs that they use to feed their children, thus preventing diseases associated with poor feeding. They also sell the birds to make good money for the household use.

The project though funding from Amref Italy has built 50 giant wells to support 20,500 people with agricultural activities and 218,940 people with access to safe water and sanitation.   The project is committed to make safe and affordable drinking water, hygiene and sanitation a reality for the people of Kitui County.

Amref Health Africa 

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This CSIR Female Researcher Is One Of Few Stem Cell Reprogramming Experts In South Africa

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Dimakatso Gumede, CSIR Researcher.

Only a handful of people in South Africa have mastered Stem Cell reprogramming and Dimakatso Gumede (34) is one of them. As the CSIR’s candidate researcher of the Bioengineering and Integrated Genomics Research Group, she works on creating disease models of the innate immune system to study unique African gene variants that lead to elite controllers that naturally control viral load levels without antiretroviral therapy.

By using induced pluripotent stem cell technology, the CSIR research group also creates“mini liver”models in order to determine the adverse drug affects in the South African population.

“The African population is known for its genetic variation, which often affects the way in which an individual responds to particular medication. For example, while an aspirin may work effectively for 70% of the population, it is possible that the remaining 30% may experience adverse effects. Therefore, as part of CSIR’s Bioengineering and Integrated Genomics group, we are looking to create effective and personalised medication for those who do not respond positively to the drugs that have been distributed for the general population,” says Gumede.

Gumede, who is a PhD scholar of the University of Cape Town (UCT), recently submitted her doctoral thesis. She studied the role of a gene mutation that causes skin and lung fibrosis, using a scientific method called induced pluri-potent stem cells. This approach produces any cell type in the body, such as skin or lung cells, which, in this case, provides insight into how an inherited dermatological condition is associated with lung fibrosis – a condition caused by uncontrolled scar formation that affects the organ and air sacks.

However, this was not Gumede’s original project. Initially, her PhD project was on cardio genetics, and she was working with the late Prof. Bongani Mayosi and Dr. Gasnat Shabooden at the UCT Hatter Institute for Cardiovascular Research in Africa.

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“While I was busy with my initial research project, the late Prof. Mayosi suggested that I shift the focus of my project to the study of a rare genetic condition that is associated with lung, skin and muscle fibrosis. I was excited because not only was it a ground-breaking research project that would serve as a massive breakthrough for the South African medical science sector, but it would also provide me with the opportunity to apply my cell biology expertise,” says Gumede.

With the assistance of Prof. Susan Kidson and Dr Robea Ballo, Gumede focused mainly on the cell biology of the rare skin condition in question. She learnt a great deal about reprogramming skin cells into pluripotent cells to understand what causes this gene mutation, how this rare skin condition develops at cellular level and how or why it affects organs such as the lungs and muscles and prevents them from functioning properly.

“I discovered that the gene mutation that causes this condition accelerates cell division, which contributes to fibrosis in the affected individuals and is also associated with cancer progression,” says Gumede.

Further, according to Gumede’s Principal Investigator at the CSIR – Dr Janine Scholefield, her ability to not only master but, explain highly technical and advanced science in isiZulu and Sesotho is what makes her so highly prized at the CSIR.

“She has mastered the craft of communicating her work fluently in isiZulu, Sesotho and English which is so important. With science and technology shaping our lives daily, it ought to be accessible to all, especially young people wanting to pursue a career in science. Having a young black woman who is at the top of her game and is able to make the work we do relatable is what will continue to inspire young girls entering the science field. It also makes her even more invaluable to the CSIR and the scientific community at large” added Dr Scholefield.

With the skills that she has gained, she aims to use her PhD to further establish the stem cell platform for precision medicine, drug screening and, possibly, commercialisation in the CSIR. She also intends to use the stem cell and genome engineering platforms to find new approaches to eliminate HIV reservoirs in infected persons and, hopefully, also contribute in finding key therapeutic strategies that resolve excessive scar formation in heart and lung conditions, which are a great burden of disease worldwide.

CSIR

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The African Union Appoints Amref Health Africa Global CEO to Board of Africa Centre’s for Disease Control and Prevention (Africa CDC)

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NAIROBI, 8 August 2019: Amref Health Africa Global CEO and Co-Chair of UHC 2030 steering committee, Dr Githinji Gitahi has been appointed as a member of the Governing Board of the Africa Centre’s for Disease Control and prevention (Africa CDC).

Dr Gitahi will join the Governing Board of the Africa CDC pursuant to article 10 of the statute of the Africa CDC. Dr Gitahi was appointed by the Commissioner for Social Affairs, Her Excellency Mrs. Aminra Elfadil of the African Union Commission.

The Africa CDC supports all African countries to improve surveillance, emergency response, and prevention of infectious diseases. This includes addressing outbreaks, man-made and natural disasters and public health events of regional and international concern. It further seeks to build the capacity to reduce disease burden on the continent.

“I would like to extend my gratitude to the African Union and specifically to H.E Mrs Elfadil for this appointment. I am honoured to be nominated to this position that is geared towards strengthening and transforming the health in Africa. I look forward to sharing my expertise and skills as we work towards achieving Universal Health Coverage and achieving health security in Africa,” said Dr Gitahi.

The Africa CDC is also a specialized technical institution of the African Union that serves as a platform for Member States to share knowledge, exchange lessons learnt and build capacity.

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This appointment comes after his nomination as the co-chair of the UHC2030 Steering Committee in December 2017. UHC2030 is a World Bank and World Health Organization (WHO) forum for achievement of universal health coverage (UHC) by 2030 and has membership across countries, private sector and civil society organisations.

About Amref Health Africa

Amref Health Africa, headquartered in Kenya, is the largest Africa based international non-governmental organisation (NGO) currently running programs in over 35 countries in Africa with lessons learnt over 60 years of engagement with governments, communities and partners to increase sustainable health access in Africa. Amref Health Africa also incorporates programme development, fundraising, partnership, advocacy, monitoring and evaluation, and has offices in Europe and North America as well as subsidiaries; Amref Flying Doctors, Amref Enterprises and the Amref International University.

Credit: Amref Health Africa

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