Advocacy note for International Migration Day 2018- UHC in...
UHC2030 warmly welcomes Dr Githinji Gitahi, Global CEO and Director General of AMREF Health Africa Group, as the new Co-Chair of the Steering Committee joining Takao Toda, of Japan.
We interviewed him to find out more about his hopes for UHC2030 and what challenges we might face.
What made you want to join UHC2030 as Co-Chair of the Steering Committee?
I am a medical Doctor and have worked in the health industry for many years, and more recently with Amref Health Africa. I am interested in the key drivers of lasting health change and believe in the focus on universal health coverage (UHC) as the roadmap to achieving good health for all people. UHC is key. It reflects the challenges we face in affordability, accountability, accessibility and integration of services, leadership, governance and management.
I am passionate about UHC as a subject at the national and global levels and I want to work with others so that I can see UHC become a reality in my lifetime.
What do you hope to contribute? What do you hope to get out of it?
I am a very strong believer of promoting UHC in Africa. I am a stronger believer of UHC globally but I have a passion for it in Africa because African populations, as well as those in the general South, are the ones who are living in poor settings. They have informal sector jobs and therefore it is more difficult to have comprehensive tax funded schemes or social insurance pooling. I am a great supporter and passionate ambassador for UHC in Africa because it’s those who are most financially vulnerable who also do not have financial protection for access to quality health services.
What do I hope to do? Number one is that I hope to gather political momentum for UHC in Africa and the wider south. Number two is to support the transfer and sharing of knowledge about UHC, so that different countries can learn from each other. Number three is to promote active people participation and engaging the communities in UHC. This is what UHC2030 is about. CSOs are the best placed to engage the voice of communities and create an active citizenship. We need to see the role of CSOs strengthened, and see CSOs not only as recipients of development aid but also working through the public sector in their country, so that they are partners in funding and implementation. This is part of what I want to deliver.
From a personal point of view, I want to learn. I want to learn from others and to grow which will help me play a better role.
What do you consider to be the added value of UHC2030?
Obviously UHC2030 is not coming from nowhere, it comes from an existing international health partnership (IHP+) that focused on donor funding. The real value of UHC2030 is to show that in order to achieve UHC and health for all, donor funding is really complementary to domestic financing. UHC2030 moves on the discussion that it is no longer about development and aid, it is about domestic financing and about models that have succeeded and about sharing examples of good practice. It is about showing that it can be done in different countries within each country’s context where there is no single model but a common objective.
Beyond that it is a huge moment for health and human rights. Instead of health being a privilege for people, UHC2030 captures health as a human right. When you talk about health as a human right you start to see a different glow on people’s faces when they feel they have a power over this. It is no longer coming from Government. It is not that we are powerless recipients of gifts, but that we are a participant of the right to health which is part of our social contract with our governments. We must not refer to health care as FREE; health care is funded by people’s taxes. Even the poor pay taxes through VAT. These are the taxes the government uses to provide healthcare. How then can it be free?
The moment you call it free, people see it as a privilege and are not able to demand for better quality health care and its availability. UHC2030 will convert this discussion to publicly-funded healthcare rather than free health care.
What kinds of challenges do you think that we will face as UHC2030 in the coming year?
For me, and for the Steering Committee and for all of UHC2030 partners, coming out of our discussions, the transition from a donor-focused discussion to a more integrated and systematic approach is a challenge. Aid-recipient countries tended to come to the table of IHP+ as seeking financing and to present their data to donors. UHC2030 is not about donor-recipient conversations, it is about participating as equal partners and asking how we achieve a coherent agenda for health for all. The motivation therefore for the Ministers of Health and Treasury to actively participate in a forum that is going to question their strategy, activities, accountability and political will is inherently challenging. So the motivation for recipient countries to participate actively in UHC2030 is a challenge.
Within our fragmented political agenda, there is a challenge of resolving the long-term goal of UHC with the short-term goals of governments. We say we want UHC by 2030 but UHC does not necessary get achieved with a political cycle. Governments will make declarations but they also have the short-term interests of their voters in mind, and need quick results and for those results to be reflected in the next voting cycle. Again, I see that translation of the political declaration to action to be a great challenge.
Another challenge is ensuring that civil society will come to the table to discuss directly with the Ministries. The Ministries have in the past embraced organisations, which do not question their lack of accountability. Those that do question their lack of accountability are not welcomed into the processes. We need to overcome this so that CSOs are active partners that help build the strategy.
From a CSO perspective, what do you anticipate/hope for from UHC2030?
I hope that we will develop a strong civil society that is engaged with UHC2030 and that is engaged with communities and people in order to focus on UHC. I hope that overall public interest wins. With this achieved, I hope that CSOs will be visible in the public sector and in policy and implementation processes so that CSOs are genuine and equal partners in the journey towards UHC.
To achieve UHC you need to negotiate with the public. CSOs are in a strong position to do this because they have the trust of communities, whereas the government does not always have this. This is a powerful tool that can be used to bring communities and the public into the scene. Trust is the currency of exchange for UHC in low-income and informal settings.
Is there anything else you would like to add?
Yes, the role of a health systems approach for UHC is vital because it is here that we can discuss policies that support responsive health systems built from the community level.