As we entered Rwanda’s airspace and began our final descent to the Kigali International airport, I looked out of my window, eager to get my first glimpse of the city. The view of the skyline at night is breathtaking. The city spreads out over several hills and valleys, which is befitting as Rwanda is known as “The Land of a Thousand Hills”.
The Nigeria Health Watch team was in Kigali to attend the Africa Health Agenda International Conference 2019 (AHAIC 2019), alongside stakeholders from around the world vested in advancing critical conversations initiated in Nairobi during AHAIC 2017 and exploring ways for Africa to achieve Universal Health Coverage (UHC) by 2030.
Co-hosted by Amref Health Africa and Rwanda’s Ministry of Health, the AHAIC 2019 conference brought into the spotlight the greatest health challenges facing Africa and how new research, innovation and political commitments can solve those challenges and advance UHC, under the theme “2030 Now: Multi-sectoral Action to Achieve Universal Health Coverage in Africa”.
In a compelling opening speech, Dr Githinji Gitahi, CEO Amref Health Africa, noted that, “Access to health care should not be a lottery of where you are born and how wealthy your family is.” He was the 2019 Co-Chair, together with Hon. Dr Diane Gashumba, Rwanda’s Minister of Health.
Representatives from the health ministries of Rwanda, Ethiopia, Kenya and Uganda shared their countries’ progress on UHC and the roles of the private sector, community health workers and individuals in achieving health for all. Hon. Stella Opendi, Uganda Minister for Health – General Duties said, “Uganda is yet to establish her own national health insurance scheme, but the plans are already in the works and we hope to do it in the next few months.”
AHAIC 2019 was also a vehicle to recognise those who were committed to advancing health for all in their countries. Hon Dr Gashumba, received the UHC Presidential Champion Award on behalf of His Excellency Paul Kagame, President of Rwanda and Hon Dr Amir Aman, Minister of Health – Ethiopia, accepted the UHC Ministerial Champion Award for their exemplary efforts to expand health care access to their population.
On the second day, Hon Dr. Diane Gashumba opened the first plenary session on access to care, in conversation with Senait Fiseha Alemu, a Health Extension Worker from Ethiopia. The issue of remuneration was discussed as community health workers were not being remunerated for their work, even though they played a critical role, supporting and serving the health needs of local communities. The discussions focused on a range of interventions that would help motivate the community health workers, including performance-based remuneration, education, professional development opportunities as well as placing an emphasis on the importance of community recognition.
Her Excellency Mrs Toyin Saraki, Founder/President of The Wellbeing Foundation Africa, Hon Sarah Opendi, State Minister for Health, Uganda and others came together for an invigorating conversation around social accountability for UHC. “We must match the intelligence and knowledge of communities with global innovation. Too often national or global policy decisions simply don’t make it effectively to the frontline,” Mrs Saraki said.
At a side meeting organised by the Development Research and Project Centre (DRPC), Senator Lanre Tejuosho, Chairman of the Senate Committee on Health said that Rwanda’s health budget as a share of GDP stood at 17% as the country had abided by the Abuja Declaration. “We can see the success they have achieved in UHC. Although this declaration was named after Abuja, we have not achieved 2%.” Dr Enyantu Ifenne Chairperson of the National Health Insurance Scheme (NHIS) emphasised that National health coverage was about correcting inequities and ensuring that those who were vulnerable were taken care of.
DGI Consult has developed a monthly State Social Health Insurance Scheme (SSHIS) newsletter which shares the current health insurance status of all states in Nigeria. The February Score Card shows that 27 states have passed the health insurance bill into law. However, enrolees are currently accessing care in only 8 states. As Nigeria progresses towards achieving UHC by 2030, the Nigerian government should understudy the Rwandan Health Insurance Scheme to understand what works and begin to adapt it to the Nigerian context.
The conference’s final plenary kicked off with an in-depth conversation on how to define and improve quality care across diverse settings. Panellist Dr Miriam Dahir noted that if the patient cannot accept the care, then it is not quality because quality care is that care that meets the needs of the patient.
Innovations driving change and leapfrogging progress towards UHC in Africa were also discussed – including robotics and artificial intelligence (AI) to facilitate healthcare delivery developed by MINT Innovations; strategies to leverage existing product supply chains to deliver essential medicines, developed by ColaLife; digital innovations to reach the last mile and advance health equity, such as electronic immunisation registries that give frontline health workers easy access to data on every child developed by PATH, to name only a few.
The conference’s stirring closing session was dedicated to women who are changing the world, from the community to the halls of global policymaking. Cynthia Oning’oi, a passionate advocate against female genital mutilation (FGM), received a standing ovation for her inspiring and brave speech on being subjected to FGM and her drive to save other girls from suffering the same fate. The Women in Global Health (WGH) Africa Chapter was launched following a signing ceremony between Dr. Gitahi of Amref Health Africa and WGH Executive Director Dr Rhoopa Dhatt.
In honour of International Women’s Day, several women were recognised for their leadership and tireless work in global health: Senait Fiseha Alemu, a CHEW from Ethiopia; Nice Nailantei, Global End-FGM Ambassador; Prof Miriam Were, Champion for an AIDS-Free Generation; Hon Dr Diane Gashumba, Rwanda Minister of Health; and Katja Iversen, CEO of Women Deliver.
Eleven parliamentarians from Ghana, Kenya, Rwanda, Senegal, Tanzania and Zambia launched the “Kigali UHC communiqué,” committing to strengthening health systems, addressing health inequities, supporting community health and ensuring universal access to immunisation to drive progress on UHC in their countries.
There is no UHC without citizen involvement. They are the main stakeholders without whom UHC would be meaningless. It is important that citizens & Civil Society Organisations (CSO) engage with decision makers. They must know when, how and where decisions are made, understand the budgeting process and hold decision-makers accountable for the promises they make.
When it comes to Universal Health Coverage, one country’s success is all of Africa’s gain. If countries collaborate and build on each other’s strengths, achieving UHC by 2030 may become a reality.
How can African countries collaborate to achieve UHC by 2030? Let us know what you think!
The Nigeria Health Watch Team attended AHAIC 2019 with the support of Christian Aid UK Nigeria, which works in delivering Closing the Gap to Sustainable Health Care Access through Health Insurance (CHAIN) in collaboration with Nigeria Health Watch to lead civil society dialogue and policy-advocacy, which improves Nigerians access to healthcare. A huge thank you to the Christian Aid Team!