“Call-to-Action” – Putting People First: The Road to Universal Health Coverage in Africa

Kigali, Republic of Rwanda

We, participants at the first-ever Africa Health Forum, convened by the World Health Organization Regional Office for Africa, and hosted by the Government of the Republic of Rwanda, from 27 to 28 June 2017 in Kigali, Republic of Rwanda,

Cognizant of our broad representation of the African people: Leaders and policy makers, ministries of health and finance, development partners, inter-governmental agencies, the African Union Commission and Regional Economic Communities, the private sector, academia, philanthropic foundations, youth and women organizations, nongovernmental organizations, civil society organizations and the media,

Mindful of the theme of the Forum, “Putting People First: The Road to Universal Health Coverage in Africa” and Africa’s commitment to attain the highest possible level of health for its people as articulated in the WHO Constitution, the African Union Health Strategy 2016 – 2030 and Agenda 2063, and the Transformation Agenda of the WHO African Region,

Acknowledging the progress made in health outcomes – improved life expectancy at birth, reductions in adult mortality rate, under-five mortality rate and maternal mortality ratio – due to better availability, coverage and utilization of health services,

Concerned that despite the progress made, inequities in service provision still persist, with a high burden of communicable diseases such as HIV, TB, Malaria and NTDs, as well as noncommunicable diseases; and numerous public health emergencies that have the potential to destroy health systems and communities, disrupt national economic activities and threaten peace and security, all against the backdrop of a demographic transformation with rapid urbanization and climate change; and limited focus on interventions that affect health but are out of the control of ministries of health,

Recalling the adoption, in September 2015, of the Sustainable Development Goals (SDGs) in general and SDG3 in particular – “ensure healthy lives and promote well-being for all at all ages” – especially with Universal Health Coverage (UHC), defined as “all people receiving the good-quality promotive, preventive, curative, rehabilitative and palliative services they need without suffering financial hardship in so doing” as one of its targets,

Recognizing that the 2030 Agenda for Sustainable Development will require health systems strengthening, which includes implementing the “Global Strategy on Integrated People-Centered Services” and ensuring public health security, including better preparedness and response to disease outbreaks and epidemics and other public health emergencies,

Reaffirming our commitment to putting people first, promoting synergies and coordination and engaging all stakeholders behind the goal of achieving UHC, while leaving no one behind,

Hereby commit ourselves, individually and collectively, to:

• Keeping UHC as the overarching approach for attaining SDG3 in order to ensure healthy lives and promote well-being for all at all ages;

• Sustaining strong political will and commitment, increasing and sustaining domestic and external financial contributions and investments in health, including establishing innovative financing mechanisms, ensuring value for money and increased accountability;

• Building, re-orienting and re-aligning health systems towards UHC, with a emphasis on primary health care, and maintaining effective systems to ensure improved financial protection and affordability for the most vulnerable populations, including women, children and the youth while intensifying focus on quality and equity;

• Strengthening health workforce development and sustainability, including community health workers, to deliver quality health services;

• Empowering people, including the youth, with the information, skills and resources that will enable them to actively engage in health policy development and maintain healthy environments, improve health literacy thereby making effective decisions about their own health and that of their families and communities;

• Placing stronger focus on building national core capacities for the International Health Regulations, including outbreak and emergency preparedness and active engagement of communities, while mobilizing strategic partners within and beyond the health sector to address the social and environmental determinants that influence vulnerability related to health emergencies;

• Establishing well-coordinated multisectoral regional emergency mechanisms and teams to support countries for prompt response to outbreaks and other health emergencies supplementing  national capacities when needed;

• Strengthening advocacy and national capacity for health research, including setting the agenda; improving infrastructure, regulatory mechanisms and human capacity for the generation, analysis, synthesis and use of research and other health data, and mobilizing the required funding;

• Promoting, through partnerships, the use of new technologies, including innovative eHealth solutions to support the attainment of UHC;

• Establishing well-coordinated multisectoral monitoring and progress-tracking mechanisms to promote efficiency and accountability in delivering on key health-related commitments to achieve concrete results towards attainment of UHC;

• Creating new opportunities for improved partnerships and an enabling environment that brings together the different stakeholders to undertake transformational change, including strengthening legislative frameworks, regulatory capacity and financial management, and reorienting public policy-making and the health workforce. 

Call upon:

• Government to provide leadership and stewardship for actions aimed at creating consultative planning platforms and regulatory frameworks for the attainment of UHC;

• Government to increase domestic investments; mobilize and coordinate all stakeholders for a common purpose; forge partnerships with bilateral and multilateral agencies, the private sector and civil society; and monitor and report progress;

 WHO to intensify its advocacy and convening role across governments, foundations, civil society, academia and the private sector to ensure that the SDGs in general, and UHC in particular, remain at the top of the political and development agenda, and that adequate domestic and external resources are mobilized;

• The African Union Commission to intensify its advocacy and convening role with African leaders and governments and ensure that the highest political will and commitment are mobilized and sustained for UHC and the SDGs;

• WHO and partners to support countries to sustain focus on accelerating efforts to address the burden of HIV, TB, malaria and NTDs; building on the progress made in reducing maternal mortality and addressing women’s health; and ensuring that resources are mobilized for health research, noncommunicable diseases and the social determinants of health;

 WHO and the International Telecommunication Union (ITU) to support the scaling up of eHealth solutions in the context of UHC and the SDGs;

• Development partners to increase their investments in UHC, including in health security, and improve resource alignment to country priorities as set out by governments, in line with the Paris Declaration on aid effectiveness;

• The private sector to increase its investment in health, while making the most of opportunities and mechanisms such as research and development, public-private partnerships, local manufacturing of health  products, direct technical assistance and corporate social responsibility actions;

• WHO and the African Union Commission to help strengthen the capacity of Member States, facilitate and support the sharing of country experiences and establish mechanisms for monitoring progress towards the realization of the actions as set out in this “Call-to-Action”; 

Thank His Excellency Mr Paul Kagame, the President of the Republic, the Government and People of Rwanda for successfully hosting the First Africa Health Forum;

Request the WHO Regional Director for Africa to extend congratulations of the Africa Health Forum to the newly elected WHO Director General, Dr Tedros Adhanom Ghebreyesus; 

Request the WHO Regional Director for Africa to present this “Call-to-Action” to the Sixty-eighth Session of the WHO Regional Committee for Africa;

Request the WHO Regional Director for Africa to establish a biennial platform to engage key stakeholders in reviewing progress towards the health-related SDGs and in identifying common strategies to expedite the achievement of UHC.

Done at Kigali on 28 June 2017