March 15, 2021

Dear Diary: Reflecting on the Role of Commissioner

These past few months, I felt rejuvenated, energised and saw the passion I have for better health systems come to life, like never before. I have been avidly following and supporting my colleague Simon Marot Toulong Facebook posts as his dream is to one day be Commissioner in his home town in South Sudan. He already calls himself, “Slim Commissioner” and we often joke about it. Never had I imagined that I would have a Commissioner role of any sorts before comrade Simon. He was actually the first person I messaged when I received news that I had been selected to serve as the recent Africa Health Agenda International Conference (#AHAIC2021) Commission on the State of Universal Health Coverage (UHC) in Africa.

As a Commission, we had only six months to get into gear. A clear term of reference (TORs) arrived setting out our deliverables and expectations, and we kicked off regular meetings to work towards delivering a report. Here I was, sitting with the greatest minds on the continent as we openly debated, argued, proposed solutions on every aspect of UHC from a pan-African vantage point. Although, I must admit, I was sceptical if we would ever deliver anything within a short six month period; given the depth of knowledge, the differing rich perspectives, the magnitude of health issues on this continent, and the consensus needed.

On my end, slowly the realisation dawned and deep sense of responsibility kicked in, this was the opportunity to shape the narrative on issues I have been working on at both the policy and community level for healthcare in Africa (gender, adolescents, youth and people with disabilities). The Commission co-chairs; Professor Edwine Barasa and Dr Solange Hakiba and the AMREF organising committee provided an open space during every single meeting to air our views and for us to set the tone and level of our contribution, to really shape the narrative needed to take UHC forward. It was extremely exhilarating to be able to offer strategic insights, technical inputs, play devils advocate on many issues and rack my brain about concrete solutions which could actually take the continent forward for what’s dubbed the ‘next decade of action’. During one of my reflective thought sessions or rather my regular ‘conversation with myself’, I challenged myself, “What can I really bring to the table, what can I offer, what can I really do for patients on this continent?” 

Six months later, it is hugely exciting to see the State of UHC Report come to life. What stands out for me or keeps me up at night, is this 50% mark we are at when it comes to service coverage, patient access, women’s access to health and the fact that the quality of healthcare is the poorest performing indicator of UHC in Africa. You can have a full read here:  The recommendations from this Commission are strong, my absolute favourite one is that we need investments in physical infrastructure to leverage the opportunities of digital health. As I said during the conference last week, we have to be practical, we have to advocate on the physical infrastructure on our continent, else, all we are set to see is digital health inequity.

Dear Diary, I feel emotional and humble and look back on this journey having achieved two things within the Commission, pushing to have patients and communities voices featured strongly within the report and ensuring that we unpack what it really means to “leave no one behind” by offering “Practical Steps towards Achieving Universal Health Coverage for Persons with Disabilities”, check it out

No doubt, this was possible because of an enabling robust space, clockwork coordination and leadership, the sorts of spaces which are and must be created to spark energy and action. I first met Dr. Githinji Gitahi when I graduated from an AMREF Health Africa short course on health systems strengthening and he shook my hand at the graduation, I am pretty sure he doesn’t remember it! Bumping into him again at the recent Commission meeting in Naviasha, Kenya, my exact words to him were, “Doc, I am very excited about this Commission, it’s not just a by-the-way, it’s real, concrete and meaningful, that’s important.”

Two things to consider as we move forward “Dear Diary” and everyone reading this, 1) how do we create more of these enabling spaces or structures which run like a well-oiled machine on the continent and 2) which areas of the report will we advocate on massively to ensure we move beyond the meagre 50% mark when it comes to UHC on the continent?

Dr Shakira Choonara is an award-winning independent public health practitioner, and pens #ThoughtSpace with a touch of inspiration, critical thinking, and creativity

Tweet: @ChoonaraShakira
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