There is unprecedented political commitment to universal health coverage (UHC) in sub-Saharan Africa today as well as a set of well-developed technical solutions and tools for helping to make progress toward this goal. But while many governments have translated their commitments into country-specific UHC plans, they face obstacles in their implementation and breakdowns in the process of translating known solutions to action to spur progress toward UHC. As a result, implementation falters, commitment risks erosion, and equity, quality and financial protection issues persist.
So what are some of the barriers encountered in the UHC process at country level?
- While health financing policy interventions exist, and are recognized as a critical lever to ensure that movement towards UHC can be efficiently, effectively and equitably achieved and sustained, how to implement, combine and sequence these is country-specific.
- Technical knowledge is critical for implementation; however other skills like communication, advocacy, and facilitation need to be reinforced to enhance using and sharing knowledge and information to build consensus and make progress.
- There are political economy challenges, including lack of involvement of vested stakeholders at country level (such as ministries of finance, the private sector and civil society) that undermine country ownership and support of the UHC agenda.
- Linkages at the sub regional level among these stakeholders are also underdeveloped; regional sharing of experience and solutions could be better leveraged to help individual countries advance.
- “UHC and health financing advocacy” is often presented in the abstract, limiting effective understanding and support within the population.
Health financing policymakers are increasingly aware that other sectors and actors have a role to play in ensuring the success of health financing interventions, and whose voices and priorities need to be heard in the health financing and UHC dialogue. This includes broadening the discussion to public finance actors; a more earnest inclusion of the private sector and other stakeholders; and the engagement of advocates who understand country politics, community mobilization, and technical interventions.
There is unrealized potential to leverage the existing mandate and convening power of regional technical bodies, networks and institutions to support regional knowledge exchange, while expanding accountability for progress towards countries’ UHC commitments. Multiple other initiatives are active in sub-Saharan Africa, such as HHA Communities of Practice, the Joint Learning Network, and research institutes, and can be tapped to mobilize and build on country, regional and global experience.
The African Collaborative for Health Financing Solutions (ACS) is a 5-year (2017-2022) USAID-funded project working with regional bodies and country-level multi-stakeholder platforms to share knowledge, strengthen accountability and promote health financing policies and processes that advance UHC in sub-Saharan Africa (SSA). Led by Results for Development, ACS mobilizes a diverse team of African experts and international organizations, including Duke University’s Global Health Innovation Center and Feed the Children, to support learning and accountability for UHC at the national and regional levels.
Leveraging R4D and partners’ experience with collaborative learning, governance, health financing, and private sector and community engagement, ACS strives to support change agents at the country level to better navigate their own path to UHC. ACS aims to find synergies with existing UHC and health financing initiatives and to amplify them by working on a demand-driven basis to build country skills in facilitation, learning processes, communication and accountability that will help evidence-based technical solutions gain traction. Working closely with local and regional organizations and building on existing initiatives, ACS aims to:
- Support transparent and inclusive country platforms for accountability and knowledge to share learnings, identify challenges and test solutions
- Build capacity and collective stakeholder commitment for a structured, iterative learning process at the national level, and among countries in a sub-region
- Leverage regional networks, organizations and institutions to advocate for accountability in health financing and share knowledge to support and advance country priorities.
To begin, ACS will embark on a consultation phase, engaging a multitude of stakeholders including implementers and policymakers to better understand both country-level and regional partner priorities and implementation challenges in order to shape our interventions and assess demand.