Tennis might not have much to do with healthcare, but Arthur Ashe extracted a universal concept. “Success is a journey, not a destination. The doing is often more important than the outcome.” It’s important for realistic plans for Africa’s long-term goals for Universal Health Coverage (UHC).
It’s impossible to argue sensibly against the goal of UHC. For Africa, affording it, and its eHealth component’s a huge challenge. WHO says UHC’s goal “is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them. This requires:
- a strong, efficient, well-run health system;
- a system for financing health services;
- access to essential medicines and technologies;
- a sufficient capacity of well-trained, motivated health workers.”
Achieving UHC needs an emphasis on people and an increase in healthcare spending for each person. It’s obvious and understandable that Africa doesn’t spend enough on healthcare. Affordability’s been a long-standing constraint, but spending numbers from the World Bank shows how healthcare spending’s changing.
Africa compared to global
In 2013, Africa spent an average of about US$150 per person on healthcare. Globally, spending was almost US$1,140, so a huge gap for Africa to close, and it’s widening. The spending range has increased by about 17% over the previous five years, but this may not represent Africa’s progress. It’s spending since 2008’s increased by about 30%. Globally, the increase’s about 11%. Africa’s making progress, but it may be challenging to sustain. Average spending in 2013 dipped by about 3% over 2012. Despite this, Africa’s healthcare spending overall’s made considerable progress.
Africa’s not all the same
The picture across Africa’s a bit different. The high average growth rate of 30% over five years reflects a narrowing spending range. The difference between top and bottom’s a reduction of about 10% since 2008. It shows that overall, countries are moving in the right direction, but, there are some important details. Some countries are the very bottom of the spending league table may be stuck. Some at the very top may be reducing spending per person.
This may be partly due to increasing and changing populations. Africa has the world’s fastest growing population. An eHNA post summarised these. It directly affects the healthcare spending per person numbers and trends, giving African countries two UHC challenges:
- Catching up the rest of the world
- Keeping up with its increasing number of citizens and patients and their needs and demands.
What’s eHealth’s role?
When UHC was set up in developed countries, such as the UK’s NHS, eHealth wasn’t part of the landscape. Now, it offers an increasingly wide range of opportunities to run health services more efficiently, provide health professionals with clinical data they need and to use analytics to improve healthcare’s effectiveness.
eHNA’s post on WHO’s 2015 global eHealth survey shows Africa lagging behind globally. With little in the way of legacy systems, Africa can take advantage of eHealth’s growing potential. The growth in healthcare’s finances should have a sustained allocation for eHealth as an essential resource to help to make a bigger difference as new types of eHealth come on stream in the future. It needs integrating with the steady recruitment, training, development and retention of the extra health workers needed to move towards UHC.
Affordability constraints mean that a set of slow burn eHealth investments is the core option. This isn’t easier than big bang. It brings its own set of challenges, such as architecture, interoperability (IoP) and cyber-security weaknesses at interfaces as new initiatives, such as the Internet of Things (IoT), genomic databases and eHealth that hasn’t been imagined yet.
Patience is needed for these to come to fruition with UHC. Eduardo Galeano, the Uruguayan writer offers an appropriate strategy. “Utopia is on the horizon. I move two steps closer; it moves two steps further away. I walk another ten steps and the horizon runs ten steps further away. As much as I may walk, I'll never reach it. So what's the point of utopia? The point is this: to keep walking.” If requires eHealth strategies build on long-term eHealth visions. No visions = short term fixes.