How COVID-19 is derailing Universal Health Coverage – Report

The global economic losses from the COVID-19 pandemic has made the quest for achieving Universal Health Coverage (UHC) more difficult, causing a tremendous setback in the shaky progress of the 2030 Sustainable Development Goals (SDGs) agenda, the 2020 Goalkeepers Report has said.

The report released on Monday but embargoed for Tuesday by the Bill and Melinda Gates Foundation said many low and middle-income countries (especially in Africa), who are lagging in the quest for UHC due to gender and geographical inequities, will now face a daunting task due to the impact of COVID-19.

Leadership will determine how much progress the world makes on poverty and disease in the aftermath of the pandemic, philanthropists Bill and Melinda Gates write in the report.

The couple, for the past 20 years, has been investing in health and development in low and middle-income countries.

The Goalkeepers report is the foundation’s annual scorecard on the world’s progress towards achieving global goals.

Every year, the Goalkeepers report tracks 18 data points related to the Sustainable Development Goals, narrowing in on those the Gates Foundation is primarily focused on.

Tracking impact of COVID-19

Titled ‘COVID-19, a global perspective’ this year’s report tracks the impact of the virus on especially the health indicators of the SDG.

UHC, which entails providing effective access — including financial risk protection — to at least essential healthcare for even the poorest and the most vulnerable population, is key to achieving the world’s SDGs.

It is the central target of the SDG 3, one of the 17 goals set by the United Nations General Assembly in 2015 for the year 2030.

The UHC Effective Coverage Index produced by IHME includes 23 indicators that, together, are a shortcut for thinking about whether people in a country have access to essential health services.

This year, COVID is pushing these numbers down, the report found.

“Supply chains are cut off; PEP (personal protective equipment) are scarce; and resources are being shifted to acute COVID care,” the report said. “Demand is down, too, as people avoid (or can’t get to) health facilities. Because the UHC index is a composite across different services provided through health systems, no single action can reverse person’s health needs over the course of their lifetime.”

In Africa where health interventions such as family planning, eradication of major diseases like HIV, tuberculosis and malaria are largely dependent on foreign donors, it is now more than ever at risk.

Even the well-developed countries that contribute hugely to interventions such as the Global Funds are crippled by the contagion which has spread to over 200 countries infecting nearly 30 million, killing more than 900, 000 across the globe.

Maternal, child deaths

Achieving targets of SDG 3 includes ending preventable deaths of newborns and children under five years of age by 2030.

While the world is still lagging in reducing infant deaths, the report found that children are mostly vulnerable during the pandemic.

“Current data suggests that children are less likely to have severe disease from coronavirus infection than older adults. However, as coverage for routine immunisations decreases and case management for pneumonia and diarrhea have been interrupted due to the pandemic, children are increasingly vulnerable,” the report said.

“Models predict that acute malnutrition will increase dramatically, which will make it harder for children to fight off infectious diseases.”

In its latest report titled Levels and Trends in Child Mortality, UNICEF, the UN children’s agency, warned that the COVID-19 incursion is capable of derailing decades of progress toward eliminating preventable child deaths.

“While the extent and severity of the mortality impact of COVID-19 on children and youth is still unknown, the potential of a mortality crisis in 2020 threatens years of remarkable improvement in child and adolescent survival from 1990 to 2019, the period covered in this report,” the agency said.

The report also revealed that Nigeria has become the world’s number one contributor to deaths of children under the age of five after it overtook India last year to secure the unenviable position.

Even though Nigeria is among African nations that subscribed to achieving UHC by 2030, about 145 women of childbearing age and 2,500 children under 5 years of age die daily in the country.

‘Off-track’

Nigeria is among countries that are already off-track from achieving UHC in Africa.

Last October while delivering a keynote speech at the yearly national health dialogue organised by PREMIUM TIMES, Mohammed Dogo, a former Executive Secretary of the NHIS, Nigeria’s health insurance agency, presented a paper that showed the country is “already off track” from achieving the target.

He listed nine impediments to the quest for achieving UHC in Africa’s most populous nation to include weak funding models and systematic bottlenecks.

Mr Dogo said the three tiers of governance in the country pose a serious bottleneck for the easy “cascading of policies and interventions” that will drive UHC.

He said the Nigerian constitution was not specific on who is directly responsible for health in the three tiers of government.

“These are evident in the country’s response to COVID-19. Federal and state strategies are not in sync as seen in the run-ins between the NCDC, Nigeria’s infectious disease agency and states such as Kogi and Cross Rivers. Primary

Health Care system was not included in the response plan.

“Until recently when agencies of government at the federal level are having their state counterparts working in synergy, we may not achieve UHC,” Mr Dogo said.

Funding primary healthare as gateway

Steering more spending into PHC (and relatively less into secondary and tertiary care)—and spending that money more efficiently—will lead to better patient outcomes, according to Goal Keepers index.

“Ultimately, it will also lead to the goal of UHC,” it said.

The Gates report, which proffered several ways UHC can be funded builds on the resolutions from the Africa Health Agenda International Conference 2019 (AHAIC) held in Kigali, Rwanda to reinvigorate the continent’s quest for UHC.

Providing an affordable option for Africa’s poorest will determine whether countries achieve SDG 3, which is to “ensure healthy lives and promote well-being for all” by 2030, Githinji Gitahi, CEO Amref Health, explained in his first press briefing at the conference.

“Financial protections for the vulnerable is embedded in what universal health coverage means by definition, which is a concept that overall looks at how to provide quality health services to people without them struggling to afford it.”

Eleven million Africans are pushed into poverty every year by medical expenses, according to the WHO.

Also, according to the Goalkeepers report, the COVID-19 crisis has thrust almost 37 million more people into extreme poverty, after 20 straight years of that number coming down.

At the same time, it has revealed how fragile that progress is.