The Alma-Ata declaration of 1978 emerged as a major milestone of the 20th century in the field of public health.
The conference reaffirmed that health is indeed a fundamental human right.
Moreover, the attainment of the highest possible level is an important social goal world-wide, whose realisation requires the action and input of other sectors other than the healthcare sector.
At the time, gross inequalities in healthcare status of the people in both developing and developed countries were worsening, which made health inequality a global concern.
To ensure equitable healthcare access globally, the concept of primary healthcare (PHC) was born, which aimed to improve access of health care to individuals, communities through their full participation and at a cost they can afford.
This PHC was to be made an integral part of the national health system for countries implementing it.
After the World Health Organisation and United Nations International Children’s Emergency Fund (UNICEF) adopted the Alma-Ata declaration, they began to continuously emphasise the importance of primary healthcare and ‘health for all’.
These laid the groundwork for the universal health coverage (UHC) policy framework.
The universal health coverage policy thus gained populace over the years, especially in the early to mid-2000s when many nations began to adopt and incorporate in their national health systems.
Since then, WHO continued promoting and supporting the implementation of the UHC all over the world.
In 2015, the United Nations General Assembly 2030 agenda for sustainable development was set, which includes the targets of achieving UHC, namely financial risk protection; access to quality essential healthcare services; as well as access to safe, effective, quality and affordable medicines and vaccines for all.
Progress globally
There has been slow but considerable progress towards achieving universal health coverage globally, with many nations reaching alarming stagnation in 2019 henceforth.
The wake of the Covid-19 pandemic saw an exponential rise in healthcare spending globally, and out-of-pocket-spending on essential health services.
The most-affected groups were the poor or previously disadvantaged groups.
WHO revealed that essential services were disrupted in 92% of the countries globally at the peak of the Covid-19 pandemic.
Namibia’s progress thus far
Namibia’s path to UHC implementation began with a policy framework in 2018.
There has been multiple stakeholder engagements and national dialogue on how to sustainably implement the framework.
Cabinet approved the UHC framework in 2023 and a directive has been given to the interministerial committee led by representatives from the health ministry, works and transport ministry, the National Planning Commission as well as the ministry of finance and public enterprises to work on the funding and implementation mechanisms.
Namibia currently meets the requirements on access, affordability and quality of health services, which are the basis of UHC.
The WHO Universal Coverage Index states that Namibia is ranked between 65% and 70%, making it one of the top performers in Africa in terms of progress towards UHC.
Despite drawbacks caused by the Covid-19 pandemic which, among others, resulted in increased healthcare spending, Namibia is at a pivotal point in its journey towards UHC implementation, especially with the recent approval of the UHC policy by Cabinet last month.
What it means for our country
Adopting and integrating the UHC in Namibia would mean that all the people will have access to the full range of quality health services they need, when and wherever they need them, without financial hardships.
The full continuum of essential health services – from health promotion to prevention, treatment, rehabilitation and palliative care will be available and accessible to every citizen regardless of their socio-economic status, age, gender, disability, sexual orientation or their nationality.
This will mean that the delivery of these services will be done by healthcare workers with optimal skills mix at all levels of the health system, who are equitably distributed, adequately supported with access to quality assured products.
Moreover, the policy seeks to protect individuals from the financial risks of paying for health services out of their own pockets and reduce the risk further impoverishing such people because of the cost implications that come with accessing improved quality health services.
Forging forward
The Government of the Republic of Namibia can point to many strengths in its health system.
Tax-funded, public health services cover over 80% of the population, with most services available for free or minimal charge.
A well-developed private health system, funded through voluntary insurance, covers about 20% of people.
There is a large network of primary healthcare facilities spread across the vast but thinly populated country, with links to district and referral hospitals.
To complement its newly-developed UHC policy, Namibia requires a more dynamic healthcare system in which all sectors and institutions must put all hands-on deck to mobilise resources to ensure a remarkable improvement in all aspects of healthcare.
Furthermore, sufficient human resources, adequate infrastructures and resourceful management of medical commodities are required to further drive the UHC agenda in Namibia.
More broadly, resolving the disparity in socio-economic status will ensure greater coverage in terms of accessibility to healthcare services for poorer populations.
Lastly, countries that achieve their UHC targets by 2030 will be able to eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies such as Covid-19, reduce financial hardships linked to illness, and strengthen the foundation for long-term economic growth.
*Dr Essar Mateus holds a MBChB from the University of Namibia. He is a Master of Business Administration candidate in Healthcare Management at the University of Zamibia.