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Monday, 18 December, 2017

Writing in All Africa, Graça Machel calls on political leaders to prioritise health and urges investment in healthcare across Africa to ensure access is affordable for all.

In our ongoing fight for health and justice, let us again recall the words of Nelson Mandela: "health cannot be a question of income; it is a fundamental human right."


Graça Machel in New York, in 2015 (Credit: Neville Elder / The Elders)

Access to health is a human right. The Constitution of the World Health Organization states that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being" .

It follows that if people cannot live healthy lives or access the health services they need, then they cannot enjoy all their other human rights. And if policies, institutions and systems restrict access to health care and prioritise profit over people, then that constitutes a denial of fundamental human rights.

In the past week, the world has marked both Human Rights Day on December 10 and Universal Health Coverage Day on December 12. Civil society groups, human defenders and community activists came together to form a movement based on solidarity and hope, recognising that the struggle for health and human rights are two sides of the same coin.

These struggles are especially acute in Africa. Hundreds of millions of Africans are faced with the appalling choice between seeking life-saving medical care and putting food on their tables.

This is a matter for outrage. It reflects a collective lack of political commitment to health across our continent. Members of the global community committed to the UN Sustainable Development Goals in September 2015 where 193 countries pledged to invest in achieving Universal Health Coverage (UHC).

I am personally committed to the cause of UHC through the work of the Graça Machel Trust, and also as a member of The Elders – the group of independent leaders founded by Madiba to work for peace and human rights, which is today led by Kofi Annan.

Universal Health Coverage is rooted in equity and rights and is therefore a cause that is near and dear to the Elders. In July this year, we launched a Walk Together campaign, to mark the organisation's 10th anniversary and the upcoming centenary of the birth of our founder, Nelson Mandela.

Through this campaign, we are standing alongside over 1,000 organisations that are part of the global Universal Health Coalition to shine a light on extraordinary stakeholders delivering health care around the world.

I know from personal experience in southern Africa that affordable, accessible and quality health care is vitally important in building inclusive, prosperous and sustainable societies.

Earlier this year, I travelled with my fellow Elder Mary Robinson to Tanzania to meet ministers, officials and community members to see first-hand how that country is trying to widen access to health.

We met many inspiring people, especially outspoken civil society activists, and heard from rural women who have minimal access to health facilities and face unaffordable user fees to obtain treatment.


Graca Machel and Mary Robinson in Tanzania in July 2017. (Credit: The Elders)

We also received the unfortunate impression that funding primary health care and investments in service delivery are not yet at the levels required.

Policymakers need to afford it the highest priority in their budgetary decisions. Primary health care is the cornerstone of health systems, connecting patients with trusted health care providers who can address the most common health needs throughout their lives. We are at time in history were knowledge, capacity and resources combined can eradicate the tragedy of preventable deaths.

One of the first acts of Nelson Mandela as president of a newly democratic South Africa was to grant access to free health care for women and children under five. We see the benefits of decisions like these in Nigeria's Ondo State, for example, where the provision of free health care for pregnant women has reduced maternal mortality by three quarters.

African political leaders, and indeed leaders globally, need to place health as a priority, and confront the powerful vested interests of private medicine and the pharmaceutical industry to ensure access is affordable for all.

Investment in human capital through better education and health care is the best way to improve skills, capacity and productivity needed for future economic growth and innovation.

One of the biggest challenges African health systems face is the lack of reliable data. Therefore, strengthening the collection, analysis and application is key to ensure that any investment made target the system's weaknesses to enhance health care delivery.

The scale of need is certainly daunting. In Kenya, 83 percent of people lack financial protection from health care costs; in South Africa, over 80 percent of people are not covered by health insurance. The evidence is clear, however, investment in health care and promotion of universal coverage is imperative and can strengthen social cohesion and solidarity, and help rebuild trust in public institutions.

Malawi has never charged user fees in public health facilities, and has a child mortality rate of 64 deaths per 1,000 – in contrast to 109 in Nigeria, which is seven times wealthier.

Ethiopia provides universal and free primary health care services to the entire population through an extensive network of 37,000 community health workers.

These are examples that all countries in Africa can use as a reference. In our ongoing fight for health and justice, let us again recall the words of Nelson Mandela: "health cannot be a question of income; it is a fundamental human right."

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