The possibility of universal health coverage

Alice Tembe, CNS Correspondent, Swaziland
CNS image library/2013
The Government of the Kingdom of Swaziland, through its Ministry of Health, has made some strides toward achieving Universal Health Coverage, through promotion of patient centred health care delivery, designing of mobile health care models that do not wait for patients to come to the health centres but actively go out to where the patients are, provision of subsided health care services, and free treatment programmes.

Led by the Ministry of Health, this initiative purports to increase quantity and quality of health care services and go beyond treatment and management for prevention of disease onset through public education and awareness. However, these milestones do not come without their challenges—that seem unsurmountable at times.

The World Health Organization (WHO) Director General, Dr Margaret Chan, noted that ‘I regard Universal Health Coverage a single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.’

It suffices to say that unfortunatley this works in an utopian world. By default, the speed of development determines the priorities in health investment in any part of the world. While some countries are working towards elimination and prevention of disease, others are still battling with management of the peak of disease crisis-- thus begging the question, can there be real Universal Health Coverage? Going by the definition of WHO, the goal of Universal Health Coverage is to ensure that all people obtain the health services that they need, without suffering financial hardships when paying for them. This requires:

  • A strong, efficient and well run health system

  • A system for financing health services

  • Access to essential medicines and technologies and

  • A sufficient capacity of well-trained, motivated health workers

In a country like Swaziland, which is located at the extreme end of Southern Africa; is landlocked; with a population of approximately 1million, and over 70% of its youth unemployed; having the highest burden of HIV and facing a potentially catastrophic economic meltdown, adherence to Universal Health Coverage guidelines is an uphill task.

In Swaziland, the health system development was derailed by the repeated changes to split and consolidate health care delivery in the past three decades due to HIV/AIDS and the re-emergence of TB. While efforts were made to provide free treatment for those affected, the realities of transport and food cost hindered a large population from reaching the healthcare facilities and hence missing out on the much needed treatment. Furthermore, the never ending exodus of healthcare workers to neighboring South Africa and Namibia as well as to the United States of America, United Kingdom and Australia, has impeded not only consistency in care delivery but also hampered the development of a strong, efficient and well run health care system. As new and recently graduated health care workers keep getting introduced in the system to replace the experienced health care workers, the focus remains on training for basic health care delivery rather than improvement.

The over-reliance on the health care system of neighbouring South Africa has also slowed down the growth of the Swazi health care system. There is patient initiated reliance on the South African health system perpetuated by the porous border relationships between the countries. Then there is also the official government led Phalala Fund-- a healthcare funding system that supports patients needing specialized care in South Africa that they cannot afford.

Such, and other, issues pose a high bar of challenge for most developing countries to meet Universal Health Coverage. It begs the need to attain basic needs like food, shelter and employment before construction of a healthcare centre close to the patient. There is a need to holistically develop a health care system that not only attracts well trained health care workers, but also provides enough motivation to retain them for consistent and measurable growth and quality improvement, noted Dr. Thandolwakhe Tembe, a Medical Doctor at the Mbabane Government Hospital.

This, in concurrence with Dr Chan’s plea, calls for a comprehensive and holistic approach to attain Universal Health Coverage, and each sovereign country should treat it as an integral part of its national priorities and strive towards accomplishing it.

Alice Tembe, Citizen News Service - CNS
1 January 2015