Health Benefit Packages and inclusion of health products to increase UHC in Sub Saharan Africa

Introduction

Universal Health Coverage (UHC) represents a foundational goal in global health policy. It aims to ensure that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. However, the global effort to achieve UHC by 2030, as outlined in Sustainable Development Goals target 3.8, is currently falling short. Progress in expanding health services coverage has stalled since 2015, and the percentage of people experiencing catastrophic out-of-pocket (OOP) health expenses has steadily increased since 2000 across all regions and most countries.

In the WHO African Region (AFRO), the UHC service coverage index has shown some improvement over the past two decades, but the rate of progress has slowed since 2015. In 2021, the index declined slightly from 45% to 44% compared to 2019, likely influenced by the COVID-19 pandemic.

While there has been some reduction in the number of people pushed into extreme poverty due to OOP health expenditures, the percentages facing impoverishing health costs at the 10% threshold and those experiencing catastrophic OOP expenses have stagnated over the last two decades. This situation underscores the need for targeted policy changes in the region (WHO AFRO, 2023).

Total health spending in SSA is low, averaging just $92 per person in 2021, with projections suggesting a further decline to $86.30 by 2050. Many countries in the region rely heavily on external funding, with almost half depending on it for more than one-third of their health expenditures. In contrast, domestic government contributions average only 40%, significantly lower than the global average (63%).

Specific data on health product spending in LMIC’s is scarce, especially in SSA. Estimates indicate that medicines account for a large share (between 20-60%) of health expenditures in LMICs. Of that share, OOP payments are the primary source of funding (50% to 90%). This reliance is even more pronounced among the poor. The data behind these figures is over 20 years old, there is an urgent need to update this data to ensure sound policy recommendations but also for policy interventions that address affordability and access to essential medicine.