/ 11 August 2016

​The Elders fight for health for all, but especially for vulnerable groups

A doctor listens to a tuberculosis patient at the Blue house clinic in the Mathare valley slums in Nairobi.
A doctor listens to a tuberculosis patient at the Blue house clinic in the Mathare valley slums in Nairobi.

The right to health is a basic human right, one that depends on access to timely and affordable healthcare of appropriate quality. Yet we know that about 100-million people globally are needlessly pushed into poverty every year as a result of costly healthcare expenditure.

Nobody should be forced to choose between seeking medical care and staying out of poverty. It is unacceptable that families, sometimes whole communities, are denied life-saving health services and forced to pay unaffordable fees for their care.

This burden is particularly felt by women, children and adolescents, who often have high needs for healthcare but the least access to financial resources. The needs of these groups were identified as a priority in the sustainable development goals, adopted by 193 countries during the United Nations general assembly last September.

The Tokyo International Conference on African Development (TICAD), which takes place in Nairobi on August 27 and 28, is a moment when decision-makers can take steps towards universal health coverage.

At last year’s conference, Japan issued a loan of ¥4-billion ($39-million) to the Kenyan government to work towards universal health coverage by 2030. We hope this year’s conference will see even greater commitment, from all sides.

The Elders, the group of independent leaders founded by Nelson Mandela to work for peace and human rights, which is today led by former UN secretary general Kofi Annan, is campaigning for universal health coverage because of its basis in equity and rights. We believe that everyone must be covered, with services allocated according to people’s needs and health systems financed according to people’s ability to pay.

In our own countries, emerging from decades of colonial and military rule, we know from personal experience how important affordable, accessible and quality healthcare is in building inclusive, prosperous and sustainable societies.

We also know that this requires both unwavering political leadership and public financing commitments. Governments and global development partners should develop and implement health financing strategies that increase levels of public financing and reduce the role of inefficient and inequitable private financing, especially health service user fees.

It is essential to allocate these public resources efficiently and fairly, in particular to services that benefit the most vulnerable. Priority should therefore be given to primary healthcare, especially maternal, newborn and child health services. This is the process Japan, for example, underwent in 1961 when it made its own giant leap towards universal health coverage.

Many African countries are still to make this transition. In 30 sub-Saharan countries out-of-pocket costs account for nearly one-third of total health financing; in some countries, such as Nigeria and South Sudan, this rises to 70%. At these levels, the poor are in effect excluded from the health system. And this can have dire consequences on the population as a whole when health emergencies such as the Ebola epidemic occur.

But some African countries are achieving impressive results. Malawi has never charged user fees in public health facilities and allocates 5.6% of its gross domestic product to public health financing — above the 5% target the Elders urge governments worldwide to commit to spending on health. Malawi has a child mortality rate of 64 deaths per 1 000 — in contrast to 109 in Nigeria, which is seven times wealthier.

Ethiopia has made tremendous progress towards universal health coverage and now provides free primary healthcare services to the entire population through an extensive network of 37 000 community health workers. Countries such as Malawi and Ethiopia prove that, even at low income levels, if governments prioritise health in their budgets, it is possible to provide free health services to everyone. In turn, this brings huge health and economic benefits.

As the development economist and Nobel laureate Professor Amartya Sen argued in 2015, universal health coverage is “an affordable dream”. We applaud Japan for its leadership in promoting universal health coverage to other countries and hope the African leaders gathering in Nairobi will heed Sen’s words and invest substantial political capital in making this dream a reality for their people.

Graça Machel was Mozambique’s first education minister and is now an international human rights advocate. Ricardo Lagos is the former president of Chile. Both are members of the Elders.