Collaborative synergies in East Africa for Universal Health Care

Joseph Checky Abuje

The pharmaceutical industry in Africa have for along time been faced with a myriad of challenges that are now threatening service delivery in the health sector, especially in sub-Saharan Africa to the detriment of Universal health Care (UHC).

Among the challenges are lack of trust, language barrier and lack of defined regulatory frame work among member states. Others include non-centralised system to adopt recommendations from NRAs(National Regulatory Agency), lack of mechanism to domesticate regional guidelines as well as lack of electronic system to track the progress of the industry.

CS Nakhumicha visit children’s ward at Nangina mission Hospital in Western Kenya

Players in the sector at the continental level are however optimistic of achieving the desired results  and are now agitating for speedy interventions from African States to ensure collaborated coordination in developing frameworks and regulatory mechanisms that will foster quality and accessibility to medication as envisaged in the Africa’s Universal Health Coverage mission and vision statement under the United Nation’s Sustainable Development Goal(SDG3).

In an interview with AstraZeneka Senior Regulatory Affairs Manager, Ms Angeline Achoka on the sidelines of a high level Sub-Saharan Africa stakeholders engagement on the future of Africa’s pharmaceutical industry, early December 2023,she  pointed out that divergent national interests among countries is a pointer to the slow progress towards common good of effective service delivery in the industry, that requires flexibility, early stakeholders engagement and sharing of best practices among member states.

“This is key for the effective roll out of Universal Health Coverage as envisaged in Africa vision 2030” Madam Achoka stated.

She however expressed confidence that the future of pharmaceutical industry in Africa and by extension, the roll out of Universal health care, is promising to alleviate the threatening  poverty situation in the region.

Her sentiment was echoed by the Director of Human Medicine – Burundian Regulatory Authority for Medicines for Human Use and Food, Dr Salvator Sindayigaya who said language barrier is a hindrance to the realization of meaningful progress in the pharmaceutical industry across the horn of Africa.

Addressing  industry participants from East and Central Africa, United States Trade and Development Agency (USTDA) Regional Director for sub Saharan Africa, Ms Heather Lanigan confirmed support for strengthening the sector, noting that USTDA is currently supporting more than 140 activities in the region, and Africa is poised to improve and expand its health provision following its strong ties with partners . “We are committed to scaling up the industry for efficiency” Lanigan disclosed.

According to Victor Ogallo, Deputy CEO Kenya Private Sector Alliance (KEPSA), Africa has great potential in the pharmaceutical industry if regional harmonization of regulations is amicably addressed to create one common market for medical equipment in the continent. He termed the current operating regulations as “desperate” that cannot attract more investors. “Harmonization of pharmaceutical regulations will save Africa a huge chunk of money  spent on importing medical equipment. In 2021, Africa spent a whooping USD 25billion on importation of pharmaceuticals” said Ogallo

“Africa’s spending on pharmaceuticals is low, with a big fraction of the population spending out of  pocket for lack of shared expenses on medication, making the continent have low per capita of USD 25 against world average per capita of USD 160” says Ogallo, Deputy chief executive officer, Kenya Private Sector Alliance.

However, Stakeholders who included medical professionals, technocrats from the private sector are hopeful of streamlining the industry operations through measures among which include centralization of systems alongside adopting voluntary compliance on regulations and adoption of technology system that support  online applications to track registration processes.

In East Africa for instance, much strides have been made as far as harmonization of regulations to govern pharmaceutical industry in the region to help fastrack the roll out of Universal health Coverage, which for long time has been a mirage due to financial constraints, policy frameworks  and high cost of medical care among other factors.

Many African countries are today relying on the advantages of universal health coverage to cushion their rapidly growing population against poverty because of expensiveness of affording health care out of pocket. Most families, for instance in the Kenyan context have been compelled to dispose off their property including land to carter for medication bills after depleting their sweat-earned savings. And this is a replica to other regions in the horn of Africa and beyond.

The Kenyan president William Ruto is on record saying that his administration is keen on ensuring that the Universal Health Care scheme gives every Kenyan access to affordable, equitable quality healthcare irrespective of their financial status. However, this is yet to be seen as initiative still has patches of grey areas, and for that reason, quick and well thought out interventions need to be put in place sooner than later.

Some of the intervention African countries are taking to ensure success in attaining Universal Health Coverage besides harmonization of regulations in the pharmaceutical industry include strengthening of community based health insurances, healthcare decentralization as well as prioritization of health promotions . Other practical actions are disease prevention and enhanced basic curative services in all health institutions.

Sub-Saharan Africa has put its best foot forward and impressive progress of Universal Health Coverage roll out has been seen and largely attributed to sound government policies around the implementation of the scheme that revolve around health infrastructure development, human resources for health and health financing.

However, one of the impediments pulling back the gains towards Universal Health Care initiative in East Africa is corruption and falsification of documents by health institution including schools in collaboration with health insurance schemes to defraud the governments according to the Kenyan cabinet secretary for health Dr. Susan Nakhumicha. But this has elicited a sharp debate with Kenya Union of Medical practitioners led the Secretary General Seth Panyako who argues that the step taken by the Kenyan government to withdraw nurses from learning institutions, especially high schools is ill-advised.

Nonetheless, the spirit of Universal Health Coverage in Kenya and by extension in Africa is to see every citizen regardless of financial status and location access health services without any kind of impediments including and not limited to finance. But this dream has experienced a lot of resistance largely because of financial constraints, inadequate human resource as well as high cost of medication.

This has been aggravated by the fact that out of pocket mode of payment to health services is too exorbitant for most African families who live on two or below dollars per day, and has been a catalyst to an upward poverty index in the African continent.

Health Cabinet secretary susan Nakhumicha speaks to a patient in hospital

Though the Kenyan government had earmarked on full roll out of UHC by 2025 as envisaged in the health blue print of 2018, this may not be realized based on several factor that include over-reliance on foreign partners to fund the programme, limited work force in the health sector and poor health infrastructure systems in the country. These factors apply not only in Kenya, but across the region. Universal Health Coverage was one of the “Big 4” agenda of former Kenyan president Uhuru Kenyatta alongside affordable housing and food security of which their success still hangs in the balance.

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