By DR AARON MUJAJATI –
ON  December 12, 2016 the world commemorated the third annual international day of Universal Health Coverage (UHC). This year’s theme is “Health for All”, with a call to “Act with Ambition”.
There are many definitions of the UHC.
The World Bank and the World Health Organisation define UHC as “when all people receive the health services they need without suffering financial hardship when paying for them”.
From this definition one can clearly isolate the two major components that make up UHC and these are: coverage, which is made up of the health services that people need and reduced exposure to financial risk or financial hardship.
UHC is a fundamental element to achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG-3 which seeks to ensure healthy lives and promote well being for all at all ages.
The SDGs are related one to another but health is the thread that connects them all.
In order to achieve UHC it has been recommended that: countries should publicly finance their health systems; health services must be provided free at the point of delivery; user fees must be abolished; and donor coordination is critical.
Zambia abolished user fees in 2006 but Out-of-Pocket (OOP) expenditure at the point of care remains unacceptably high.
Several researchers agree that or people carry the largest burden of disease and OOP. In the 2017 budget the health sector received an allocation of 8.9 per cent of GDP but this does not include the donor funds that go directly to NGOs to fund health projects.
This is why we need to critically look at how health is financed in order to ensure that our estimates of expenditure on health services are as close to what is on the ground as possible. Social Health Insurance (SHI) has been used by many countries in Europe and Asia to achieve universal health coverage.
Zambia must “Act with Ambition” and move to enact the Social Health Insurance Bill when it is brought before parliament during the current sitting.
SHI requires specific thresh holds of socioeconomic factors to succeed. Questions have been raised as to whether Zambia has the requisite socioeconomic environment for SHI to achieve UHC.
This is a long topic for another day but the step to enact the SHI bill is an inevitable milestone to achieving UHC in Zambia.
Infrastructure, human resources for health and reliable supply of commodities are fundamental elements to coverage. It is an open secret that, like most third world countries, human resources for health remains a challenge and Zambia is not an exception.
The Ministry of Health is on schedule to employ over 5000 health workers this year against a deficit of 19,000. Zambia has invested heavily in infrastructure for example over 200 health posts having been commissioned out of the schedule 650.
The country needs to address the problem of having huge amounts drugs and other commodities expiring in face of shortages at the point of care.
Zambia has a long way to go to achieve Universal Health Coverage when one looks at the structure of health care financing; levels of human resource for health; infrastructure development; and other key socioeconomic parameters.
However, it is encouraging to note that the current government has embraced social health insurance as one of its key strategies to achieving universal health coverage.
Therefore, we recommend the following: immediate enactment of the SHI Bill in to Law; donor funding for health must be through control 99 or some mechanism that allows the Ministry of Finance to track donor funding to the health sector; a robust human resource for health development strategy; increased and sustainable public financing mechanisms of health services; rational and sustained infrastructure development; efficient procurement and distribution of health commodities; prioritize prevention strategies; and a comprehensive information system that covers both the private and public sectors to support decision making.
For further clarification on any health issues contact Dr. Aaron Mujajati, Zambia Medical Association President on email: aaronmujajati@gmail.com.