December 26, 2019

The powerful push for Universal Health Coverage

By Dr Shakira Choonara*, public health researcher and activist, part of the inaugural African Union Youth Advisory Council

“I for one am excited by the power of SRHR activists and communities and what this will bring to the UHC movement”

Having worked extensively in health policy and systems research (HPSR) and on the advocacy front in sexual and reproductive health rights (SRHR), I have been banging my head against a wall on how fragmented we are in terms of stakeholders, networks, disciplines, and programming. Even our conferences tend to happen in silos. These silos have resulted in poor knowledge sharing practices, a lack of collaboration, splintered efforts and a lack of significant traction to achieving Universal Health Coverage (UHC).

Perhaps, I shouldn’t be this critical. There certainly has been work on gender, SRHR and HPSR, so it really isn’t re-inventing the wheel either. The big question is: how do we build on this and bring it together?

This International Universal Health Coverage (UHC) day, we have been asked to tell leaders to ‘keep the promise’ they made at the United Nations General Assembly (UNGA). It is fascinating to see how an UNGA focus area can galvanise civil society to engage and act! Last year, all we heard was #enoughNCDS at the high-level meeting. The political declaration on Universal Health Coverage (UHC) this year (September 2019) has resulted in SRHR and HIV activists sitting up and taking notice. I’m not one to move from one theme to another, but UHC is a cause which is strongly supported – for as long as we don’t have strong systems, and accessible, affordable and quality healthcare no other efforts can succeed. In fact, it is only this year, in the build-up to UNGA, that many SRHR activists had begun to engage with UHC processes and policies for the first time ever. This made me consider the work that I have been involved in, and I was struck by the potential power of civil society, the power of the SRHR and HIV community in particular to engage leaders globally and nationally and get them to “keep the promise of UHC”.

I was recently appointed to the joint SRHR Africa Trust (SAT) and UNAIDS project on UHC and SRHR including HIV. This project extends into 2020 with focus on using the UNAIDS approach of “Communities Deliver” – communities at the centre, amplifying and mobilising, in this case for strengthened and responsive health systems. Especially interesting is the focus on key populations and youth. One example from key populations which stood out was that transgender patients do not fit the biological description of “male/female” and are denied care, the other issue is that health workers are not trained and sensitised to providing care – so here is a case of the right to health needing to go even further i.e. to addressing the most marginalised who are currently being excluded.

As part of the SAT/UNAIDS project I had the opportunity to lead two of three country level consultations (Zambia and Uganda). The best way to sum it up was that it was truly a wake-up call on so many fronts. The truth is, as we carry on this path, we are excluding an entire constituency – particularly communities and representative organisations who (from our initial consultations) are excluded from these discussions.

During the consultation, when posing questions around involvement and knowledge of any national level policies and shifts to UHC, the majority of participants informed us that this was the first meeting they were being introduced to the UHC agenda, or at least the first meeting in which they began to understand UHC. This was concerning, given the number of youth activists in the room, who you would expect to have an understanding of country level processes. Similarly, in South Africa (SA) when engaging young HIV activists recently, many had very little knowledge about National Health Insurance (NHI). There is a clear need to break down concepts and help others who are not in our circles to understand UHC, to grapple with its components in order to push accountability and transparency. For example, having participants discuss how their HIV experiences shed light on UHC (e.g. access barriers, quality of healthcare services and even affordability) sparked an interest and even starting to develop key SRHR advocacy asks within UHC. I have not been to the People’s Health Movement community training on the NHI in SA, but such an initiative is definitely on point!

Another example which stands out in SA is around how important it is to have that strong civil society push. Section 27 is a renowned organisation in the HIV/AIDS sphere who are focussing on drug stock outs, and this is linked to ensuring better procurement and access. Section 27 also pushed massively on the front of mental health when more than 94 patients were de-humanised by the SA health system and lost their lives – Life Esidimeni, this case pointed to the gaps in our healthcare system – the leave no one behind. I was also excited to learn more around youth efforts coalescing, young HIV activists are beginning to mobilise on UHC #Ready4UHC who also introduced the agenda at the International Conference on AIDS & STIs in Africa (ICASA), further, Amref Health Africa is also bolstering youth efforts on UHC.

Beyond this UHC Day, these examples demonstrate immense power and social capital. I for one am excited by the power of SRHR activists and communities and what this will bring to the UHC movement. I have learnt over these few months that, by holding simple community dialogues, we can unlock the power of the SRHR and HIV movement to push for key asks in UHC, which, to-date range from integrated services to transparency and accountability. It may just be the push the world’s populations desperately need.

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