Reconnecting health systems to households

Following a thought provoking few days at the successful Africa Health Agenda International Conference 2017 (AHAIC 2017) I have a lot to reflect on. The private sector attended in force which led to much (and generally positive) discussion of public private partnerships (PPPs), I heard about many exciting innovations and mobile-tech solutions. And of course, the Sustainable Development Goals (SDGs) were never far from the surface.

One phrase from the Group Chief Executive of Amref Health Africa, Dr Githniji Gitahi, has stuck with me: “We need to reconnect health systems to households.” For Dr Gitahi this can be achieved by investing in community health workers (CHWs) and transitioning community health volunteers (CMVs) to CHWs by paying them.

CHWs and CHVs provide a crucial role in ensuring healthcare is accessible for the hardest to reach. But they need motivation to do this often difficult job. Save the Children in Kenya has realised this and acted on it. During a session on community-based healthcare financing solutions for vulnerable populations, Lawrence Auma of Save the Children Kenya told AHAIC 2017 how high attrition rates of CHVs due to economic constraints was a large issue in the Bungoma County of western Kenya. In response, Lawrence and others at Save the Children have provided expertise, start-up toolkits and seed funding for village savings and loans associations (VSLA) to create incentive packages for CHVs. This led to a 99% retention rate. Not only is it important to retain CHVs due to the knowledge, experience and community relationships that can be lost, it’s hugely inefficient to continuously recruit and retrain.

Beyond CHWs and CHVs, more investment has to be made in primary healthcare (PHC) as a whole. Without governments and the international community prioritising, SDG 3.8 – achieving universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality and affordable essential medicines and vaccines for all – will not be achieved.

According to data collated by WHO, per capita median public expenditure on non-primary care is up to 3 times higher than spending on primary or preventative services. Reference: http://www.who.int/health_financing/documents/public-financing-africa/en/ 

Currently, resource allocation in Africa is skewed towards high-end care, which disproportionately benefits the richest in society. Secondary and tertiary level facilities, referral hospitals and capital facilities are not always easily accessible for the poorest. Conditions that can be easily dealt with by PHC are either referred to other facilities, which create yet more inefficiency and may require a long journey, or at worst conditions are not treated at all.

PHC and UHC are not new concepts. They fell out of vogue for too long, but have come back strongly in public consciousness. National governments and the international community need to realise how efficient, effective and, most of all, equitable PHC is. Those of us who realise this need to continue to call for change, and not stop until every last person enjoys their right to health.