Universal Health Coverage (UHC) is a health care system which provides health care and financial protection to all its citizens.

 

The definition of UHC by the World Health Organization (WHO) encompasses three dimensions: Equity in access to health care, i.e. to ensure that those who need health care services should get them, not only those who can pay for them; Quality of services, which is good enough to improve the health of those receiving services; Financial risk protection i.e. universal coverage must bring the hope of a better health and protection from poverty for the people, especially the most vulnerable ones.

 

The three dimensions to UHC include:

• Providing quality health services: good enough to improve the health of those receiving services.

• Equity in access: to ensure that those who need health care services should get them, not only those who can pay.

• Financial risk protection: with hope of a better health and protection from poverty for the people, especially the most vulnerable.

 

The key features are that it includes prepayment (avoiding out-of-pocket payment) and supports risk pooling, which ensures the spread of risk across time and across individuals. See Table 1.

Table 1

 

UHC is essential for inclusive growth, health security, and sustainable economic development. To achieve UHC, more resources have to be mobilized for the health sector, and they must be used more efficiently and effectively. Deployment of eHealth for UHC also has a huge potential for massive job creation.

 

Electronic Health (eHealth): Use of Information and Communication Technology (ICT) in support of health care and health-related fields, including health care service; health surveillance; health literature; and health education, knowledge and research.

 

The proliferation of ICT in our daily lives makes it a strategic ally for public health services. It could be harnessed for solving and preventing health problems, ensuring improved quality of care and improving access to health systems. Most countries are constantly exploring different ways to mobilize additional resources and use technology more efficiently to move toward UHC within a wider social protection framework.

 

The health systems strengthening required in order to reduce waste of resources, maximize coverage, and provide better quality health care at a lower cost can most effectively be addressed with appropriate information and communication technology (ICT) investments. When eHealth is not properly harnessed, inefficiencies proliferate, UHC becomes extremely difficult to achieve and the potentials for job creation is not tapped. Effective e-health strategy can ensure that the right solutions are deployed to eliminate inefficiency (see Table 2.).

 

Table 2: Addressing health service inefficiency with eHealth

Table 2; Source: Adapted from ADB Brief –Susann Roth et al eHealth in Nigeria: The Nigeria ICT for health enabling environment is currently transitioning from experimentation and early adoption into developing and building up.

 

The federal government has recognized the opportunity that information and communication technologies (ICT) present to help accelerate the achievement of save one million lives (SOML) goals. Consequently, the Federal Ministry of Health with support from the United Nations Foundation, along with Groupe Speciale Mobile Association (GSMA), the Government of Norway and other partners has launched ICT4SOML – Information and Communication Technology for Saving One Million Lives.

 

ICT4SOML has two main goals:

1. To support the scale-up of high priority ICT for health projects through working groups targeting specific SOML program areas

2. To strengthen the ICT for health enabling environment in Nigeria through the development of a national framework that addresses gaps in the enabling environment.

 

The success experiences in ICT4SOML will afford the country a scale-up for ICT use in UHC.

Table 3. Source: Author *NHIS = National Health Insurance Scheme.

Some studies have shown that there is great support for the use of eHealth by health care workers in developing countries, despite limited availability and several barriers to its use. These findings provide a platform for further development of eHealth to improve health care decision making.

 

In addition to improved efficiency in health care delivery, deployment of eHealth for UHC also has a huge potential for assisting in the upscale, uptake, effectiveness and efficiency of the NHIS (see Table 3) as well as in massive job creation, especially in this era of economic diversification in Nigeria.

 

Recommendation for achieving UHC through eHealth:

• ICT gap analysis: To determine baseline ICT infrastructure and what hardware and software systems are needed. This also shows what policy changes are needed.

• Political will: Commitment at the highest level of governmental (executive and legislative) and non-governmental sectors.

• Multi-sectoral approach: Involving inter-ministerial lead team (health, finance, planning, ICT) to advocate for investment in eHealth.

• Technology transfer: Rather than reinvent the wheel, it is better to identify available tool and work on adaptation.

• National ID system: A national identification system is important for achieving UHC. This may not be universally available at onset but must be planned and continually scaled-up.

• Workforce/Manpower development: This allows for institutional readiness as lack of

manpower remains one of the main obstacles to implementing eHealth in every region of the world.

• Data safety and security: Despite interoperability, standards for quality, safety and ethics must be ensured. Policy for data security, privacy, and confidentiality must be in place in such a way that private information is secured.

• Sustainable financing mechanism: Financing eHealth must be planned in a sustainable manner

• Public-Private partnership: Public-private partnership with financial, technology and non-governmental sectors will allow rapid scale-up after rollout.

• Monitoring and Evaluation: ICT is of major importance in measuring progress towards UHC and in M&E. The process of M&E should be determined at the onset, should be ongoing and should measure end-user benefits.

 

Summary:

• Obtaining universal health coverage (UHC) has been widely embraced by several low and middle income countries, including Nigeria. UHC is essential for inclusive growth, health security, and sustainable economic development. To achieve UHC, more resources have to be mobilized for the health sector, and they must be used more efficiently and effectively.

• The proliferation of Information and communication technology (ICT) in our daily lives makes ICT a strategic ally in health care service. ICT innovation in health (eHealth) is a key enabler for achieving and measuring UHC.

• eHealth has the potential to reduce healthcare costs to families and improve equitable access to quality services.

• Rather than re-invent the wheel, optimizing existing ICT infrastructure, allowing for adaptation and making strategic new investments in eHealth solutions may accelerate UHC.

• Measuring UHC with ICT-enabled monitoring systems can also enhance evidence based health policies and decision making with more reliable and sufficient data in formats and frequencies that ensure better health systems performance.

 

References:

1. World Health Organization. http://www.who.int/health_financing/universal_coverage_definition/en/

2. Susann Roth et. al. (June 2015) ADB brief: Universal Health Coverage by Design

3. UN Foundation (Sept. 2014) Assessing the Enabling Environment for ICTs for Health in Nigeria: A Review of Policies.

4. N. Al-Shorbaji (Jun. 2013)The World Health Assembly Resolutions on eHealth: eHealth in Supportof Universal Health Coverage. Methods Inf Med 2013; 52: 463 – 466.

5. Carissa F. Entienne (2014): eHealth: Harnessing technology on the road towards universal health coverage. Pan American Journal of Public Health 35(5/6), 2014.

6. Adekola O. (2015). Universal Health Coverage: http://www.medicalworldnigeria.com/2015/03/universal-health-coverage-sustainable-healthfinancing-in-nigeria-through-health-insurance#.Vlw6sZe2W01

7. Adekola O. et al (2014) Perceived value of applying Information Communication Technology to implement guidelines in developing countries. Online Journal of Public Health Informatics Vol 6, No2 http://ojphi.org/ojs/index.php/ojphi/article/view/5368/4554

 

By Dr Olawumi Adekola. MBBS, MPH, Cert Insur.

([email protected])