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Universal Healthcare Coverage: Do our communities and their Leaders have any role?

By Dr. Ochie, Casmir N

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To build a life, a community and an economy, a good health provides the foundation, and the greatest wealth, they say, is health. The relationship between wealth and health can be likened to that between a vehicle and the driver.

Globally, December 12 annually is recognized as International Universal Health Coverage (UHC) day. The theme for this year (2021) UHC day was ‘leave no one’s health behind; invest in health systems for all.’ To achieve this, government at the federal and state levels are primordially committed to ensuring the success and sustenance of this laudable programme. Both the government and the governed have significant roles in this regard. The Enugu State Agency for Universal Health Coverage has been doing enormous work in this respect, presently, sensitizing and mobilizing the people concerning UHC. This opportunity must be fully utilized. In a 2017 report on UHC, the World Health Organization (WHO) and the World Bank concluded that over half of the world’s population lacks access to basic health services and that over 100 million people are forced into poverty annually because of health expenses, including the cost of transportation, other tangible and intangible costs, the cost (in terms of time, effort and money) of reaching distant facilities. Globally the issue of UHC has occupied the public health media space, being recognized as means of achieving the health-related SDG, and most countries including Nigeria have since filed into the programme

Universal Health Coverage (UHC) is a concept referring to the ability of all individuals and communities to access quality health care without suffering undue financial hardships. Financial risk protection for healthcare access and use of services remains a major issue especially among the rural dwellers, the pregnant women, the under-5, the elderly, the poorest, thus creating both socioeconomic and geographic inequity. The concept of UHC takes care of the geographical accessibility of the healthcare services, financial affordability, and patient and provider acceptability of healthcare services hence eliminating or reducing inequity. Universal Health Coverage (UHC) is increasingly recognized as the best way to achieve the Sustainable Development Goals targets on health. The success of UHC is closely linked to an effective and well-functioning primary health care (PHC) system. (WHO, 2017). The PHC system is centred around individuals and communities. This means that the UHC is also linked to the community. A community is a group of people living in the same geographical area or having common characteristics such as backgrounds, ethnicity, education, experiences, language and other social themes. Furthermore, Communities can be “groups of families, individuals and other types of networks and social circles that provide support and are often the unit on which health activities are organized and focused. These days, e-communities like WhatsApp groups, telegrams etc exist and the same benefits can also be secured here. It has been shown that community members and community-based organizations can be effective at identifying health priorities/needs, addressing health concerns, managing financial and personal processes at the local level, and evaluating health systems and holding them accountable and responsible.

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The government at both the federal and state have made smart investments in the health system to ensure the sustainability of UHC. The federal government of Nigeria has set aside part of the consolidated fund for this via Basic Health Care Provision Fund (BHCPF) and Enugu state government, through Health equity fund. The onus is now on the individuals and communities to avail themselves of this inevitable opportunity and queue into the programme. The individuals are expected to enrol and utilize the healthcare services. This has started in so many parts of this country including Enugu state. The state government has been enrolling beneficiaries across all the LGAs to ensure the smooth running of the programme and testimonies abound. Policies and actions to improve primary health care must regard community members as more than just passive recipients of health care. Instead, they should partake in the leadership with a substantive role in planning, decision-making, implementation and evaluation.

The communities and their leaders hence have crucial roles to play to ensure their community members actively participate in this programme and derive the benefits. These leaders will include the President Generals (PG) of the towns, the councillors, the traditional rulers and significant others. There should also be equitable and meaningful inclusion of the faith actors and the religious leaders. These are opinion leaders who can influence other people.

The community members should be involved in the implementation, utilisation, and impact evaluation of the UHC. The community members should exhibit a high level of understanding of UHC and its modus operandi. The community leaders should also sensitise and mobilise them on the program and its benefits and ensure adequate enrolment.

Most of our people especially the rural dwellers are underserved health-wise because they are geographically or socially disadvantaged and they still constitute a significant population proportion. Incidentally, this even predisposes the rural dwellers to an increased (more) risk of disease outbreak when compared to urban dwellers.

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Now, the 2022 general election is fast approaching with associated massive electioneering campaigns when our politicians campaign in poetry and later govern in prose. Can the communities place a high premium on UHC to these politicians to enable them heavily invest in this regard by negotiating to increase the population of the enrollees and broaden the range of services? The community leaders as well as the community philanthropists can also take up this challenge.

Various public health terms have been used to describe diverse ways a community partakes in health activities. They include Community engagement, community involvement, community participation, community mobilization and community empowerment etc. It is also a fact that UHC cannot be achieved without the substantial contribution of communities. Similarly, the individuals and communities which are the most important stakeholders in the health system – must be enabled to demand a healthcare system that is responsive to their needs and concerns and that works collaboratively to improve their health and well-being. This is service demand creation.

Consequently, policies and actions for improving primary health care must regard community members as more than just passive recipients of health care. Instead, they should be seen as leaders who have a substantive role from the beginning of planning to decision-making, implementation, evaluation and evidence-based iterative learning.

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Community members and organizations can have active roles in providing services, promoting healthy behaviour and linking people to care. The way individuals are selected for the ward enrolment committees may have implications for its representativeness and for the community’s willingness to accept their decisions. So caution should be observed at this level.

The extent to which communities are included, and play a leading role, in progress towards UHC can be political so that the community stakeholders should be up and doing. Community involvement in primary health care is essential for achieving UHC because, in practice, primary health care begins in the household and community.

Finally, our people need to be carried along by the government in a way that permits them to fully understand what solutions are being proposed and what these solutions mean for them as citizens in tackling their perceived and felt needs.  When communities do not understand the system and their rights within it, accountability suffers because they do not know what and whom to hold accountable. Therefore, the role of the community and its leaders in UHC remains enormous to ensure the success and sustainability of the UHC.

DR OCHIE CASMIR N

Consultant Public/Community Health Physician

University of Nigeria Teaching Hospital (UNTH)

Ituku-Ozalla Enugu.