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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.

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Reducing the risk of medication related deaths in Nigeria

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‘As long as we have clinicians who hide the name of prescribed medication from their patients; the rate of duplication of therapy, adverse drug reactions and drug-drug interactions will continue to increase. Patients have the right to know the medicines prescribed for them’ Adaku Efuribe

As we clamour for universal health coverage and achieving the UN SDG goal3- Ensure healthy lives and promote wellbeing for all at all ages. There is one simple step we could take to help improve the health and well- being of Nigerians; we need to bridge the gap of lack of integrated healthcare and patient centred care using a multidisciplinary team (MDT) approach. We need to put the patient at the centre of care and utilise pharmacist knowledge and input if we must prescribe legally and safely.

The rate of medication related deaths due to overdose, adverse drug reaction, drug- drug interactions can be reduced through medicines reviews and medicines reconciliation.

‘As long as we have clinicians who hide the name of prescribed medication from their patients; the rate of duplication of therapy, adverse drug reactions and drug-drug interactions will continue to increase. Patients have the right to know the medicines prescribed for them’

Medicines reconciliation/review

Medicines reconciliation is a process whereby patients’ medicines are reconciled as they move between different stages of healthcare, from primary – secondary care interface.

Also Read: Meet Mariatheresa S. Kadushi, Founder of M-afya, A Mobile App Providing Health Information In Native Languages In Africa

Pharmacist led medication review tend to be more in-depth ,capturing all the essence of patient centred care as it offers more time for the patient to ask medicines related questions which enhances concordance.

The role of the pharmacist as a ‘drug expert’ is to complete medicines reconciliation and medication reviews especially for patients taking regular medication for long term conditions like Hypertension, Diabetes, Arthritis ,Asthma etc.

In a typical Nigerian Clinical setting (public and private), when a patient has contact with a clinician, most times, the patient does not have any interaction with a pharmacist. Integrated healthcare is a healthcare model where every member of the healthcare team contributes their own quota towards excellent healthcare delivery.

This true-life story about patient X shows the importance of medicines reconciliation:

 Patient X is a 65-year-old man living in Sokoto, with a history of Hypertension; he takes amlodipine 10mg tablets daily. Patient X travelled to Lagos for a business meeting and he suffered a hypertensive crisis, he got admitted in a hospital in Lagos, his blood pressure was adequately controlled and he was discharged with two other antihypertensives. Patient X did not go through the medicines reconciliation process with a pharmacist or another clinician, so when he got back to Sokoto, he continued to take his newly prescribed antihypertensives in addition to the one prescribed by his doctor in Sokoto.Few days later, Patient X suffered hypotension (low blood pressure) and had a fall on the stairway at home, breaking his hip, which made his condition worse.

A consultation with a pharmacist during the discharge /admission process could have prevented duplication of therapy, and patient educated/informed about which medication to stop/continue and also side effects to expect. Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc. Annual blood tests are routinely checked because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.

Education and support for patients on multiple medicines

Evidence has shown that when patients understand the side effects of the medication they take, they are more likely to comply with the dosage regimen. A lot of work needs to be done in the area of patient education and information provided through medicines use reviews. The gains of patient centred care cannot be overemphasised, all medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes frailty comes into consideration for some elderly patients as well.

There has been a drive for more social prescribing, motivational counselling and interventions for patients who have suffered medical emergencies or patients with long term conditions. Evidence has shown that non-pharmacological interventions have a major role to play in achieving overall general health and wellbeing.

Integrated health care approach will reduce the risk of medication related deaths in Nigeria as well as enhance delivery of outcomes. Clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota for effective healthcare delivery. Pharmacists are part of the MDT and their expertise need to be utilised more across clinical settings in Nigeria to help prevent medication related errors and deaths. The role of the pharmacist in medicines optimisation, medicines reconciliation and patient centred care cannot be overemphasized.

Article by Adaku Efuribe: A clinical pharmacist & UN SDG Advocate, Adaku advocates for better healthcare systems. She is also a health and wellbeing coach.

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Providing Affordable Healthcare in Nigeria Should Be Everyone’s Business

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Adaku Efuribe

“It is my greatest desire that we improve the healthcare system in Nigeria and provide affordable healthcare for local communities at the grassroots so that people can have access to the care they need, when they need it, in ways that are user-friendly” –  Adaku Efuribe

The 74th UN General Assembly took place in New York last September; high level meetings were held and Universal Health Coverage (UHC) was a hot topic for the week. As expected, Nigeria had a delegation of Government representatives, NGO’s and individual advocates who are working towards achieving SDG3 and UHC in attendance. So how do we implement new policies and what are the key drivers to providing UHC for all in Nigeria?

As an advocate for UHC/SDGs, I have been lending my voice over the years calling the Nigerian Government to action towards implementing UN SDGs agenda and achieving UHC.I have studied and participated in primary healthcare provision in developed economies and can say for sure healthcare provision is very expensive, but I believe we can up our game towards providing primary health care for everyone at the point of need.

Some developed economies have used the tax system to ensure their national health service does not run out of funds, a percentage of all earnings is taxed and put aside in a ‘pot’ to supplement the health budget. From a lay man’s point of view, just like the banking system, we all bank our money at different times and we withdraw money at different times, so for a contributory  healthcare system, everyone will not fall sick at the same time, some will experience life threatening sickness at some point in their life, some would have long term conditions like CVDs, Diabetes, etc., while others would only go through emergencies or minor ailments/major diseases.

In Nigeria for instance, we have a few HMO schemes covering the organised private and public sector. The ‘common man’ on the street does not have any sort of health insurance whatsoever, which leaves them at the mercy of chance. In an unfortunate event of serious illness like cancer or organ failure, they find themselves in a situation where they cannot pay for medical services hence resorting to luck to stay alive. A lot of unavoidable deaths have occurred due to lack of funds to pay for medical treatment.

The public primary care providers are underfunded and the issue of corruption has eaten deep into the fabric of the healthcare system where funds allocated for medical equipment’s, pharmaceuticals etc. are diverted for personal use.

What plans does the present Government in Nigeria have to provide Universal Health Coverage and in so doing, contribute to the economic growth of the Country?

Sustainability can be defined as meeting the needs of today without compromising the needs of tomorrow.

‘As articulated in SDG 3, health is crucial for sustainable human development, both as an inalienable human right and an essential contributor to the economic growth of society. Health contributes to national development through productive employment, reduced expenditure on illness care and greater social cohesion.

We believe that universal health coverage (UHC), delivered through an adequately-resourced and well-governed health system, will be capable of addressing these and other health challenges. Universal health coverage must ensure equitable access to affordable, accountable, appropriate health services of assured quality to all people.

These must include promotive, preventive, curative, palliative and rehabilitative services. UHC must be supported by policies and services addressing the wider social and environmental determinants of health for individuals and populations’. Sustainable Developments solutions network

Key words for providing health systems that works!

  • Well Governed Systems- Are there systems and policies in place that can be retained and continued
  • Promotive- Do we have health promotion strategies in place to promote good health and wellbeing
  • Preventative- Are we taking preventative measures seriously, screening, vaccination, reducing CVD risk through lifestyle management?
  • Curative- When we fall ill or in times of emergency, do we have access to affordable healthcare, or does sickness lead to poverty?
  • Palliative and rehabilitative services- For terminally ill patients, do we have plans for social prescribing and support? For people engaged in substance misuse, do we have plans for treatment, rehabilitation and integration back into the society

WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage in countries: Where does Nigeria rank in the indicators?

Reproductive, maternal, newborn and child health:

  • Family planning
  • Antenatal and delivery care
  • Full child immunization
  • Health-seeking behaviour for pneumonia

Infectious diseases:

  • Tuberculosis treatment
  • HIV antiretroviral treatment
  • Hepatitis treatment
  • Use of insecticide-treated bed nets for malaria prevention
  • Adequate sanitation.

Noncommunicable diseases:

  • Prevention and treatment of raised blood pressure
  • Prevention and treatment of raised blood glucose
  • Cervical cancer screening
  • Tobacco (non-)smoking.

Service capacity and access:

  • Basic hospital access
  • Health worker density
  • Access to essential medicines
  • Health security: compliance with the International Health Regulations.

Also Read: Meet Mariatheresa S. Kadushi, Founder of M-afya, A Mobile App Providing Health Information In Native Languages In Africa

The Nigerian Government can do more to improve health outcomes and tackle poverty, by increasing coverage of health services, and by reducing the impoverishment associated with payment for health services. We can subsidise the payment for health services and provide emergency health care at the point of need by ensuring we are constantly reviewing our health policies and implementing proven international strategies. The Health budget does not in any way reflect the health needs of Nigerians, this needs to be reviewed.

As Individuals, if we take health promotion seriously, and change our lifestyle habits, then we can make changes that would reduce the cost of health as well.

Adaku Efuribe is an SDGs/UHC Advocate & Clinical Pharmacist with expertise in medicines management, integrated healthcare and health promotion.

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GE Healthcare Launches Versana Ultrasound Machines to Drive Access to Affordable and Quality Healthcare in Uganda

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GE Healthcare team displaying the Versana Premier and Versana Essential Ultrasound machines during the Uganda Society for Advancement of Radiology and Imaging Conference (USOFARI).

This innovative system is well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care

KAMPALA, Uganda, November 11, 2019- GE Healthcare has announced the launch of Versana Premier and Versana Essential for the first time in Uganda. The launch was announced during the Uganda Society for Advancement of Radiology and Imaging Conference (USOFARI).

Versana Premier is a world-class ultrasound designed for peace of mind, easy to use and easy to own. The Versana Premier ultrasound system can help deliver high-quality, personalized care, patient after patient, day after busy day. This innovative system is well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care. It also comes with local product and clinical training to help healthcare professionals gain comfort and proficiency with the system to enhance patient care.

Versana Essential is a complete ultrasound solution that healthcare professionals can learn to use quickly and productively. It enables confident clinical decision making for quick referrals and immediate clinical correlation to help scan a wide range of patients. The machine is designed with the growing medical center in mind, to provide the clinical capability and support they want without compromising the quality, reliability, and affordability needed.

Both Versana Premier and Versana Essential are part of the Versana ultrasound family, which comprises of solutions that help to empower care without compromise, balancing capability, affordability, and reliability. These innovative systems found within the GE Healthcare Primary Care Ultrasound Segment are well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care.

“We are excited to participate in this year’s USOFARI conference together with other private and public partners in an effort to continue providing the latest imaging solutions to enhance early detection of diseases and ultimately the most appropriate treatment for patients,” said Andrew Waititu, General Manager, GE Healthcare East Africa. “The launch of Versana Premier and Versana Essential is a testament of our continuous investment in innovations that help to drive access to affordable and quality healthcare for all across Uganda.”

Also Read Meet Mariatheresa S. Kadushi, Founder of M-afya, A Mobile App Providing Health Information In Native Languages In Africa

Universal Health Coverage (UHC) is part of the United Nations sustainable development goals, to ensure that every person, everywhere, should have access to quality healthcare. As part of its vision 2040 and the health sector development plan, Uganda seeks to accelerate movement towards UHC with among others, essential health and related services needed for promotion of a healthy and productive life. 

GE Healthcare

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