Key Insights in Achieving UHC
i) Scaling emerging technologies
Emerging and existing technologies can accelerate UHC in Africa and Asia if scaled rapidly. Technologies such as blockchain, artificial intelligence (AI) and mobile solutions have begun to enhance and transform the patient experience. Blockchain technology offers potential to counter fake pharmaceuticals and securely streamline medical records, while artificial intelligence can improve diagnosis and medical supply chains. Many creative mobile-based solutions also exist with the potential to leapfrog traditional healthcare infrastructure challenges.
However, such technologies need to be affordable, and clinically and economically relevant for communities, given the diverse contexts of different countries. Costly technologies that yield much-needed benefits should also be explored through measures that can make them available to the communities that need them most.
More is not necessarily better – to leverage the most impactful technologies, there is a need to first assess which technologies are working, and which ones are not, and identify opportunities for improvement. This process improves existing technologies or develops new ones that addresses current limitations, minimizes duplication and saves resources.
UNGA side event 2018: From l-r Tim Evans, World Bank, Dr Naveen Rao, Rockefeller, Dr Girija Vaidyanathan, Ministry of Health India (Tamil Nash), H.E. Sicily Kariuki, Ministry of Health Kenya, Dr Suwit Wibulpolprasert, Ministry of Public Health, Thailand.
The need for partnership to implement such technologies is critical. It is not always clear which technologies should be adopted, how to use them, and how to finance or scale them. Governments in developing countries need support in identifying the best approach to improve healthcare. There is an opportunity here for the private sector to support governments as they make such efforts by providing technical expertise, financing arrangements, or other supporting mechanisms.
For example, developing a national digital partnership roadmap would be a promising intervention to support such multi-sector approaches as it would outline the roles of various sectors in digitizing health systems e.g. guiding national data collection on health and create opportunities for collaboration to scale technologies.
ii) Community-focused interventions
The shift from traditional models of healthcare delivery to community-focused models requires developing and adopting decentralized and low-cost systems that encourage people to manage their own health.
For this to occur, there is a need to empower individual community members, including the most marginalized, to become agents of their own health. This will require empowering individual community members to realize that they are powerful and can demand for quality health as their right. This calls for leaders to listen to communities and ensure that they are responding to community needs in their health programs.
The state has a key role to play to ensure that there is an enabling environment for communities to have a say in their health. Part of achieving this will be to mobilize communities to have a stronger voice, a role which can be played by Community Health Workers (CHWs). CHWs do not have the level of authority required to influence political decisions on community health, and for this to occur CHWs should get integrated into local leadership and authority structures to enable them to have a stronger role in advocating for community health.
iii) Enhancing social accountability
With a devolved healthcare system and an increasing patient-centric approach to health, new methods of enhancing social accountability and strengthening engagement in decision-making will be needed. Tools such as citizen report cards, community score cards and civic education are currently used for social accountability. However, a lack of a clear definition of goals in programs, coupled with limited data often hampers the ability to measure and monitor impact and therefore maintain accountability. There are also limited consequences for providers or organizations if achievements regarding goals or objectives are not satisfactory.
Social accountability is often seen as a one-sided process where an institution is held accountable and reports back on its actions, while social accountability should be viewed as a two-way process to engage with service providers and identify opportunities to improve performance.
To achieve this, community empowerment should be a basic requirement. The lack of information among communities on how to hold institutions or governments accountable is currently a limiting factor. Further, there is often a lack of community ownership of the social accountability mechanisms available. The role of strong political will and governance in increasing the effectiveness of social accountability tools is critical.
iv) Multi-stakeholder partnerships
Achieving UHC calls for a shift to an ecosystem approach to partnership building, where a wide variety of stakeholders align to find practical solutions to complex healthcare challenges. Given the double burden of NCDs and infectious diseases, and an increasing population, there will be increased demand for health funding, calling for closer and more efficient cooperation between the public, private, and civil society sectors.
A key requirement for partnerships to be effective will be the ability to establish grassroot movements that connect local communities with global goals. Partnerships should be anchored on local community needs and wisdom on what works. Local wisdom can then be aggregated to inform country-level partnerships, which in turn come together to form global partnerships informed by the needs of communities around the world, making them more effective at advancing equity.
While the case for UHC by 2030 is clear, the path remains long. Ultimately, bold political leadership is needed to rally stakeholders to achieve a successful UHC system. However, the private sector also has a responsibility to step up and take a leading role to pave the way forward. All our actions must be centred on placing patients first and enabling communities to rally for health as a human right.