Achieving health gains on the way to universal health coverage in Africa
Editor's Note: This blog features insights from the recent Stories from Africa seminar series at Duke University.
Health leaders and policymakers globally have a shared interest and commitment to achieve universal health coverage (UHC) by 2030. Health systems are responding to increased demand due to population growth, aging populations with complex conditions, or prior commitments to achieve UHC. Despite health gains in the last 20 years, problems are particularly acute in sub-Saharan Africa. As economies grow to middle-income levels, they have to tackle communicable diseases while more people are living with non-communicable diseases like diabetes and hypertension. The burden of disease may be higher in low-income economies, but the complexity of this problem could well be the greatest in middle-income countries. Often, the results are escalating unmet need and in-country variation across geographies, gender, or socio-economic groups.
While increased spending is generally needed, funding alone is insufficient to address persisting or emerging gaps in quality, health outcomes, or access to care. Successful UHC efforts need both strategic design and implementation of system-level policy reforms, and capabilities within public and private organizations to support value-based care delivery innovations (beyond technology). Based on work at Duke University, we believe that a winning game plan to institute high-value health systems involves three priorities.
Priority 1: Create the financing and policy systems to encourage efficiency and innovation
Research on health innovation and policy shows that system-level transformation is achieved by incremental improvements across the health value chain. Health leaders can begin the transition from volume to value systems by developing models organized around three main areas: primary care, to create a foundation for health services; condition- or disease-specific episodes, to coordinate care to control quality and cost; and populations, to integrate care delivery across the continuum of care.
Policymakers can begin by enabling and encouraging providers to track financing and health data and to monitor costs, revenues, and utilization rates. This helps to increase accountability, especially when public money is involved. In turn, provider groups in the public or private sectors or social entrepreneurs can invest in clinical leadership, create multidisciplinary teams, and develop technology infrastructure that is interoperable across providers and platforms and can help them identify high-risk patients.
One example of this type of investment is access.mobile. Launched in 2011 in Kenya to address the lack of clinical data and record keeping, access.mobile is rolling out a fully integrated system of electronic medical record keeping that alerts high-risk patients, encourages them to seek care, reduces the total number of missed clinical appointments, and facilitates population segmentation based on data analytics. Facilities using the platform are charged a licensing fee and pay-per-message charges. They also can add on services spanning health record integration, digital engagement strategy, or full-service campaign support. Data collected through this interoperable platform is readily accessible to providers. The innovation is compliant with the 1996 Health Insurance Portability and Accountability Act on data privacy in the United States. The developer conforms to many of the act’s principles in all its operations while following local regulations for patient privacy and data sovereignty.