When I served as a paediatrician in Rwanda’s public hospitals, I devoted myself to building a future where children could reach their full potential without fear of disease. Today, as Rwanda’s Minister of Health, I can attest to the great progress our country has made to improve the health of everyone living in the “land of a thousand hills.” But I also recognize how critical it is to keep pressing onward, not only as a country, but also as a continent.
Africa is home to some of the fastest growing economies in the world, but the benefits of this progress have not been felt equally. For far too many, basic health care remains out of grasp. Millions of Africans simply do not have access to health facilities staffed with trained workers, or even to experienced community health workers. Even for those fortunate enough to live in close proximity to a health facility, many cannot afford to pay for basic healthcare services.
The time has come to commit to making affordable, quality health care the cornerstone of Africa’s development. Several African countries have taken a stand on providing health services to all their citizens, and their efforts are already paying off through healthier communities.
Twenty years ago, Rwanda was a nation devastated by genocide and war: Nearly eight in 10 people lived in poverty, our health system was all but destroyed, and one in four infants didn’t make it to his or her fifth birthday. Today, even though we still have a long way to go, Rwanda is flourishing. This is due to many factors, including a collaborative governance structure that aims to extract the most value for our people from the money spent. Rwanda’s visionary approach to prioritizing the nation’s health has also been instrumental in achieving this progress.
Combining national resources with international donor support, we have developed a system to improve both geographic and financial access to quality basic care for all Rwandans. Through our community-based health insurance scheme, called Mutuelles de Sante, approximately 90 percent of the population has health insurance, with another seven percent reached through civil, military, or private insurance. Even in the most remote villages, Rwandans can rely on local community health workers to deliver 80 percent of the preventive and primary care services and connect them to advanced care when needed. Under this system, Rwandans can access care without fear of financial ruin.
The results of this approach, driven by a deep commitment to health equity, have been striking: Since 2000, infant mortality has decreased by 66 percent, child mortality has decreased by more than 70 percent, and deaths from HIV, malaria, and TB have fallen by nearly 60 percent. Rwanda’s children were the first in sub-Saharan Africa to receive the vaccines for pneumonia and the human papilloma virus (HPV).
Other African nations are also making important strides towards universal health coverage. Each country is developing its own model to provide coverage for its people—informed and influenced by our distinct cultures, histories, populations and settings. For example, in Nigeria, President Goodluck Jonathan has been a vocal supporter of universal health care and the National Health Insurance Scheme has recently intensified internal reforms. Going forward, it is necessary that each country feel ownership of both the successes and failures of the approach they opt to take.
Whatever the approach, health systems should be participatory in nature, ensuring that communities provide “buy in” to the value of having health insurance, as well as a sustained political commitment to scale up these efforts. This will help ensure that no one remains beyond the reach of efforts to provide affordable, quality care.
The need for universal health care has never been greater throughout the world, and especially in Africa. Despite commendable progress in health over the past decades, Africa still faces the highest burden of disease, and continues to have far too many weak health systems. The recent Ebola epidemic has highlighted what is at stake for all of us if we fail to invest in both strong health systems alongside good governance.
Health coverage is also a major financial challenge. Millions of Africans suffer financial hardship due to catastrophic expenditure whenever they are sick. According to the World Health Organization, about half of health care expenses in our region are paid out-of-pocket, and a 2009 study in Health Affairs found that one in every three households in Africa must borrow money or sell their possessions just to pay these fees.
No family should have to choose between getting well and going bankrupt, especially when we’ve witnessed what a powerful force national health care can be for stability and economic growth. When governments invest in affordable health care, the whole population is healthier. There are real economic benefits: there is less absenteeism at work, and the money saved by avoiding these consequences of poor health can be invested in building stronger futures for families and communities. School fees can be paid, new business can be started, and households can build savings.
Politically, there has never been a better time for us to invest in universal health coverage. Two years ago today, the United Nations unanimously endorsed universal health coverage. Global institutions such as The Rockefeller Foundation and, more recently, The World Bank, have elevated the benefits of UHC globally, and to date more than 80 countries have asked the World Health Organization for assistance in implementing universal health coverage.
Today, we mark the anniversary of this landmark decision with the first-ever Universal Health Coverage (UHC) Day, a global call-to-action that has garnered unprecedented support from more than500 organizations.
As we look beyond the 2015 Millennium Development Goals, African leaders face an incredible opportunity: If we invest in our health systems now—which we know yields an impressive return for the investment—we can build an Africa where individuals, families, and entire nations reach their full potential. Together, we can chart a course for a stronger, more resilient Africa and world.
• Binagwaho is Minister of Health, Rwanda
