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On International Day of the Girl Child 2021, Pathfinder Nigeria trained over 150 in-school students on how to use Advance Family Planning’s SMART Advocacy Approach to advocate for change. Photo: Rain Vedutti

Story and Perspective

The Importance of Multi-Sectoral Partnerships to Achieving Universal Health Coverage

Edirin Aderemi

Ethiopia Nigeria Kenya Pakistan Burkina Faso Bangladesh

On December 12, the world celebrated Universal Health Coverage (UHC) Day—the international community came together to renew its commitment to health for all by 2030. UHC means that everyone, regardless of where they live, has access to quality essential health services without suffering financial hardship. This goal cuts across all health targets and serves as a beacon of hope for a healthier, more equitable world.

Currently, at least half the world’s population still lacks access to essential health services, and almost 100 million people are pushed into extreme poverty each year by health expenses. Health systems are being heavily strained by the pandemic, making the need for resilient and equitable health systems more urgent.

This year, Pathfinder celebrated UHC Day by hosting a panel to discuss the importance of multi-sectoral partnerships and coordination in achieving strong health systems in low- and middle-income countries. The webinar featured a diverse range of stakeholders from Bangladesh, Nigeria, Ethiopia, Burkina Faso, Pakistan, and Kenya—who play critical roles toward achieving UHC within their countries.

Country Highlights: Progress Toward Achieving UHC

Thanks to multi-sectoral partnerships and coordinated efforts, many countries are making strides toward UHC, despite the COVID-19 pandemic.

Bangladesh is making primary health care a priority.

  • An essential service package ensures all citizens access critical health services—including maternal, newborn, child, and adolescent health; family planning; nutrition services; and other support services.
  • A well-structured primary health care delivery service involving NGOs and public-private partnerships led to the establishment of community clinics, where low-income people, particularly women and children, can access care without financial hardship.

Nigeria guarantees that every citizen has a right to a minimum basic package of health care.

  • The 2014 National Health Act provides a legal framework for the organization of primary health care services. The Act addresses most of Nigeria’s health financing challenges and promotes equitable service utilization. It earmarks 1% of the consolidated federal revenue, in addition to grants from donors, partners, and other funding sources channeled through a Basic Health Care Provision Fund.
  • The 2019 Basic Health Care Provision Fund ensures equity, health care financing, and risk protection for low-income populations. Since 2019, 6,287 health facilities across 31 states were cleared to receive funding.

Ethiopia is ensuring underserved populations can access quality health care services.

  • “Envisioning Ethiopia’s Path toward UHC through Primary Health Care (PHC),” is a 20-year long-term strategy to build a resilient health system. Within this strategy, Health Sector Transformation Plans were developed in collaboration with regional health bureaus and development partners. At the center of Ethiopia’s Health Sector Transformation Plans has been the growth of the Health Extension Program, staffed by close to 40,000 female health extension workers. This program has drastically improved access to quality community-based care, including sexual and reproductive health care, across the country.
  • The 2020 – 2024 Health Sector Transformation Plan II (with some targets extended to June 2030) provides quality health services to all, including underserved populations, using the PHC and community health extension programs as a cornerstone for addressing newborn and child mortality as well as inequalities.
  • Community-based health insurance and social health insurance ensure equity and financial health care financing, especially for vulnerable and underserved populations. Since 2011, the program has grown, increasing membership enrollment, renewal rates, mobilization of domestic resources, and use of health services. It has empowered community members, particularly women and girls, to be assertive in demanding their right to health and well-being.

Burkina Faso is making significant progress toward UHC, especially in financial risk coverage.

  • Since 2008, the government has consistently devoted at least 15% of the annual public budget to health care, keeping with its commitment to the 2001 Abuja Declaration.
  • In 2016, the government introduced a package of free health care for pregnant women and children under 5, which includes screening and treatment for cervical cancer.
  • In 2020, family planning was declared free in all regions of the country. The goal is to reduce the burden of maternal and infant mortality and morbidity.

Pakistan is making UHC a top priority among its health objectives.

  • The 2016 – 2025 National Health Vision aligns national programs and policies to increase health spending, improve the quality of primary health care, and rollout costed UHC benefit packages for health centers and secondary and tertiary hospitals.
  • Essential packages provide conditional cash transfer services to the poor to access health care. Further opportunities for financing primary health care are emerging, and the government plans to introduce a new project to provide free health insurance (without premiums) for all. All citizens of Pakistan will have the right to go to either a private or public health facility to seek health care.

Kenya is harmonizing efforts around UHC and ensuring civil society organizations (CSOs) have a seat at the table.

  • CSOs, through Health NGOs Network (HENNET,) are engaging with the Government of Kenya to ensure CSOs are represented and involved in all stages of planning, implementing, and monitoring UHC strategies and guidelines. Involving CSOs prevents duplication of efforts in the health sector and promotes mutual accountability for UHC.

Pathfinder’s Support to UHC

At Pathfinder, we work alongside governments and communities to improve access to health services for some of the most marginalized communities—including those affected by conflict, climate change, and natural disasters, helping them adapt, thrive, and remain secure in the face of challenges. Our support includes:

  • Enhancing the capacity of health care workers to improve the quality of care they deliver;
  • Mobilizing communities to demand access to quality health care services; and
  • Working with policymakers to prioritize funding for sexual and reproductive health (SRH).

Here are some examples of how our support is advancing UHC in Nigeria and Ethiopia.

In Nigeria, through our Gates-funded advocacy project, Advance Family Planning, we have worked closely with governments at the national and state level. [We’ve] strengthened the capacity of civil society organizations and the media to understand Nigeria’s UHC agenda and its financing mechanism for risk protection, so that accountability can be demanded.

Dr. Amina Aminu-Dorayi, Country Director, Pathfinder International Nigeria
On International Day of the Girl Child 2021, Pathfinder Nigeria trained over 150 in-school students on how to use Advance Family Planning’s SMART Advocacy Approach to advocate for change. Photo: Pathfinder Nigeria.

Pathfinder Ethiopia, through USAID’s Transform: Primary Health Care, supported the Government of Ethiopia in the development of strategic documents, including the Health Sector Transformation Plan II and the Health Extension Program Optimization roadmap towards achieving UHC. Integrated health services address the social determinants of health and establish emergency preparedness and response—which is key to achieving UHC. Pathfinder’s youth programs involve the education sector, finance sector, health sector, local leaders, and religious leaders to be part of the multi-sectoral approach in improving the health and well-being of youth across the regions.

Dr. Mengistu Asnake, Senior Country Director, Pathfinder International Ethiopia
Emebet Tesfahun, 22, receives a contraceptive implant at Finoteselam Health center, West Gojam, Amhara region, Ethiopia. Photo: USAID Transform Primary Health Care.

Lessons Learned

Although many low- and middle-income countries have made substantial efforts to provide UHC for their citizens, several of these initiatives have achieved little success due to gaps in funding. Achieving UHC by 2030 requires raising sufficient revenue to finance national health systems and improve the efficiency of revenue utilization. During the webinar, several panelists highlighted that public financing could fast-track UHC. Countries that have made advancements toward UHC have been able to do so with public financing or general revenues. Reforms need to be made to public financial management, as public sector providers cannot provide services without purchasing them from the private sector.

An important lesson we learned from the pandemic is that multi-sectoral coordination committees can improve financing for health care needs. Civil society organizations are also critical to building linkages among ministries of health, the private sector, and policymakers—ensuring that budgets are well-implemented, and actors are held accountable.

Roadmaps to UHC should consider the complex and changing needs of different geographies. Effective policy implementation and subsequent responses need to be developed. Tailored, country-specific plans and coordination mechanisms that aim to build and finance health systems that are adaptable for unforeseen changes—like global pandemics—will help accelerate progress along the path toward UHC.

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