Promoting UHC through regional cooperation in East, Central and Southern Africa

Established in 1974, the East, Central and Southern African Health Community (ECSA-HC) is an inter-governmental health organization that fosters and promotes regional cooperation in health among member states. Participating member states are Eswatini, Kenya, Lesotho, Malawi, Mauritius, United Republic of Tanzania, Uganda, Zambia and Zimbabwe. In various ways, ECSA along with these member states are working hard to promote and achieve UHC in the region.

UHC2030 spoke with Professor Yoswa Dambisya, ECSA-HC Director General and
Walter Odoch, ECSA-HC Manager for Health Systems and Capacity Development to find out more.

Can you tell us more about the role of the ECSA health community?

“The ECSA health community is one of the oldest inter-governmental health organisations in Africa, outside the African Union. Its mission is to promote regional cooperation in health among the nine participating member states. The organization contributes to the attainment of the highest standard of health of the people in the region through collaboration, capacity building, partnership, advocacy, research on health issues and harmonization of health policies and programmes.

“The Ministers of Health of the member states usually meet twice a year to provide policy guidance and direction on regional health matters. One of these meetings takes place in the member states on rotational basis and the other is held on side-lines of the World Health Assembly every May. An advisory committee, consisting of the Health Ministries’ permanent secretaries, meets before the Health Ministers. They are the management of the organization, appraise the Health Ministers on the financial and administrative issues of the Secretariat and prepare recommendations for consideration by the ministers.

“The Directors Joint Conservative Committee is a technical entity and comprises the technical health leads in countries, such as the Director of Medical Services or Health Services or the Chief Medical Officer and other members from selected health and research training institutions and health regulatory organs. It usually meets once a year following the ECSA Best Practices Forum. In this forum, promising or good practice from within and outside the region are presented and recommendations for Ministries are drawn up, based on lessons learnt. The Ministers interrogate these recommendations and pass the ECSA Health Ministers Regional Resolution.

“The ECSA Secretariat is mandated to implement the directives of the Ministers in support of the member states on regional health matters. ECSA-HC has four technical clusters including health systems and capacity development; family health and infectious diseases; food security, nutrition and NCDs; and knowledge management, monitoring and evaluation.

How have you been working on UHC?

“UHC has been the leading theme at the annual ECSA Health Ministers’ Conference (HMC) for the last three years. The themes have focused on reaching under-served populations with health services, health systems strengthening and improving service provision, and health financing for UHC. In the last HMC, held in February 2020, in Lusaka, Zambia, the discussion focused on innovation and accountability for UHC.

“The conferences are powerful as they provide a platform for sharing progress being made by countries on regional and global commitments by the member states, such as on UHC. In a way, it also acts as a “soft” accountability platform. More than that, we use this platform for the sharing of lessons and the finding of practical solutions to the challenges that member states face. It is also a forum for Health Ministers to build consensus and provide policy guidance on regional health matters, including how countries should accelerate achieving SDGs targets including UHC.  As ECSA Secretariat, we also provide specific support to countries that contributes to UHC.

“For example, in 2014, we supported Ministries of Health in Uganda and Zambia to organise national level symposiums on UHC to energise the local discourse on UHC. We think that this helped to create awareness on UHC, especially among non-health sector stakeholders and the event unlocked certain processes at the country level.

“Zambia had been trying to introduce a national health insurance scheme but discussions at the symposium revealed that legal process was stuck at the Ministry of Justice; many of the stakeholders were not aware of this issue. The meeting requested that Ministry of Health officials urgently engage with the Ministry of Justice to ensure the Draft Bill reaches the parliament for discussion and the subsequent passing of the Law on national health insurance.

“In Uganda we supported the Ministry of Health to organise a symposium to share learning about some good practices in the area of financing UHC. Stakeholders came together and shared how they can move forward. The results and the discussions from these symposiums also informed the regional resolutions on financing for UHC in the past two years.

“Although the ECSA-HC often struggles for direct attribution of its impact, through the regional engagement and cross-country learning afforded by the ECSA forums including the HMC, member states are taking lots of action around UHC.  Therefore, ECSA-HC contributes majorly through the political commitments made by the health ministers that guide the countries and development partners, and regional learning forums for knowledge sharing.

“Recently, ECSA-HC in collaboration with development partners, especially the World Bank and the Global Fund, has been engaged in supporting countries to improve quality and access for specific underperforming areas of health services, especially laboratory systems. This is in tandem with leave no one behind, but also ensuring all in need of services get the quality services that satisfy their needs, through quality and accessible diagnostic services. 

“Therefore, through our convening power, political will at the highest level in the health sector meetings and strong pronouncements on that, ECSA-HC has an advantage point for engaging other stakeholders within the countries for UHC.

Can you tell us more about this year’s theme of innovation and accountability for UHC?

“We are looking at innovative approaches within the region and one is about expanding the health workforce. A number of sessions looked at how the ECSA Health Community are working to increase the pool of skilled health workers through our college of health sciences and the constituent professional colleges. This year is also the International Year of the Nurse and the Midwife. Nurses are the biggest health professional group and for most people in our countries, nurses are the only health professional they will see.  A study has been conducted within our region through our Colleges of Nurses looking at labour market analysis and we hope to contribute to the global discourse on this.

“Through some of the ECSA working groups we are also looking at health financing to explore how different countries are approaching the issue of social protection and national health insurance with the understanding that there is no one size fits all. The other issue is how we could, as a region, improve access to medical commodities and supplies. For quite a while there have been many discussions on procurement mechanisms for vaccines and some essential medicines but because of different regulatory frameworks here, this has not worked so well.

“We are hoping that by learning about how this has been done in other regions, we can share how to unblock this issue. We also hope to share learning from an initiative called Commonwealth Moves which promotes physical activity to combat NCDs. We therefore, in a number of ways, hope to contribute to the discourse on achieving UHC in the region.

“In relation to accountability, ECSA provides the opportunity for a country to report progress on the commitments they made to achieve UHC. It is a way to apply soft pressure on member states. Most of the countries are in a similar contextual environment; if there is progress in one country then other countries are also questioning why they are not making the same kind of progress. These are the broader aspects of accountability mechanisms.

How do you engage with other stakeholders like civil society or the private sector?

“Some of our collaborating partners come from civil society; for example the regional network for equity on health in southern and eastern Africa (EQUINET) has been quite key in flagging issues of UHC. On issues of governance and ensuring equitable access to health services we have partnered over the years with the Africa Centre for Global Health and Social Transformation (ACHEST) and they provide lessons and challenges for Ministers and senior officials to address. Civil society organisations are part and parcel of the discussions and contribute to our deliberations in an essential manner.

“Our engagement with the private sector is so far quite limited. Within our region, a lot of health care is sourced from the private sector, both formally and informally, and therefore we cannot leave out the private sector. The challenge is how to do that in an organised manner that does not undermine the governmental or inter-governmental approaches we have fostered over the years. Definitely, it is agreed that without proper engagement of the private sector and without using the lessons of the private sector on how to mobilise and sustain resources, UHC will be unachievable.”

What are your hopes and expectations for engaging with UHC2030?

"ECSA-HC hopes to use UHC2030 as platform for sharing lessons, initiatives and progress on the move towards UHC in eastern and southern Africa. As one of the UHC2030 partners, ECSA-HC shall also encourage its member states to utilize the resources available within UHC2030 partnership to advance their national universal health coverage agenda."