If countries considered Universal Health Coverage (UHC) a central policy in their health systems, the COVID-19 has surely demonstrated the need for its urgent and widespread roll out. The pandemic has upended world systems in a manner that no scientists or sophisticated global intelligence could have foreseen.
Having been tapped to join the World Health Organization’s Executive Board to represent Africa midst this global crisis, I am persuaded that despite its toll, this pandemic has ‘blessings’ on its flipside. COVID-19 has exposed the global crisis of weak healthcare systems that previously lay under the carpet and forced nations’ global attention on strengthening systems to achieve UHC. Kenya, for example, has never suffered any major epidemic, having escaped the SARS, Swine Flu and even the deadly Ebola that ravaged neighboring countries. This is therefore a first and has indeed tested its preparedness for epidemics.
Thankfully for Kenya, the Covid-19 epidemic appeared in the midst of the roll-out of the President’s Big 4 Agenda, which prioritized UHC as a key pillar . The pilot implementation of UHC in four counties in Kenya has demonstrated better impact on the health outcome and greater accessibility while building Resilient and Sustainable Health system that can respond to unforeseen shocks. However, the success of UHC in Kenya will require more than executive or national-level goodwill; with health as a devolved function, each of the 47 counties must put in systems and resources to ensure its success.
The county bosses ought to prioritize delivery of a better healthcare system to citizens. This will be only be possible with a deliberate cohesive approach to UHC between the central government and the counties in order to achieve desired outputs within a short time. Both the national and county budgets have to be aligned and apportioned appropriately towards this goal.
Primarily, sufficient resources have to be channeled towards better healthcare infrastructures such as more hospitals and better equipment. However, investment in infrastructure must be done simultaneously with that in human capital. State-of-the-art equipment and beautiful hospitals without competent and well-trained personnel to handle the equipment and patients, is tantamount to wastage. As such, governments and partners ought to make enormous investments in medical and health related sciences to develop well trained healthcare professionals. The country needs to improve the current ratio of healthcare workers to population to reach every citizen with quality healthcare. Continuous medical education learning and training of healthcare workers needs to be underscored to hone their skills in latest technologies and prepare them to deal with emerging diseases.
World Health Organization (WHO) recently adopted Home-Based Isolation and Care as one of the case management strategies for Covid-19. For a continent whose populations largely reside in rural areas, this change in strategy has highlighted the importance of competent, capable and motivated community health volunteers. The community health volunteers have become crucial tripods of the healthcare stand during this pandemic. Whereas most of the CHVs may not necessarily have college training in health-related fields, their experience and informal training has gone a long way to help alleviate the challenges of Covid-19 in communities.
Kenya has for example trained and oriented 60,000 CHVs to handle patients who may present with Covid-19 symptoms. Guided by a carefully thought out Community Health Policy (2020-2030) and Guidelines on training of community health workers on COVID 19, the trained CHVs are approximately 70 percent of all CHVs in the country. The training and commensurate results from the CHVs during this pandemic has demonstrated that CHVs are a key component of the UHC success. Apart from making UHC work better, the need for more and better-trained CHVs will also be a credible avenue for job creation, especially at a time when the economy has taken a massive hit and many people with diverse skill sets are jobless.
Covid-19 has been a perfect crucible for testing the effectiveness and efficacy of technology in healthcare management. Due to the unpredictability of the epidemic and having led to total and partial lockdowns, Kenya’s CHVs received relevant information about Covid-19 through text messages, once again proving that technology is indeed the present and future of healthcare management.
Apart from achieving healthier nations, Universal Health Coverage will also be a great opportunity for multilateralism. If Kenya, its neighbors and the whole region were to invest in more hospitals and better quality of healthcare, medical tourism would grow considerably. The increase in number of patients will in turn drive up revenues and eventually lead to a drop in the cost of healthcare, much to the benefit of even local citizens. This has been the model of nations like India, whose cost of healthcare has become relatively affordable due to huge numbers of global citizens seeking medicare in their country. For India and other medical destinations, technology has also played a pivotal role in healthcare since it enjoys advanced medical technology for faster and more accurate diagnosis and management.
Advanced medical technologies such as telemedicine and compliance with international quality standards will further guarantee health tourists of excellent healthcare services, thereby creating investor confidence and opening up the region further to economic investment and strength.
Covid-19 pandemic must be a turning point for nations that have not prioritized Universal Health Coverage. A healthy citizenry is a surety towards economic growth for any nation. The success of UHC will however largely depend on the political goodwill, policy priority and a well-trained and properly equipped army of healthcare workers. There can be no better time to mainstream UHC than today. The Chinese proverb on planting trees is applicable for UHC too: the best time to start was 20 years ago, the next best time is now.
Dr. Patrick Amoth is the Ag. Director General in the Ministry of Health in Kenya and is also the Vice-Chair of the World Health Organization Executive Board.