International health development has had its fair share of fads and slogans that in most instances tend to divert attention from what is really important. As the post-2015 debate and consultations on the replacement Millennium Development Goals continue; there appears to be a common understanding that irrespective of the goals that emerge, the targets should aim towards achieving universal health coverage rather than assumed proportions of the population.
But universal health coverage (UHC) is not a new concept or development. Previously, the WHO has massively promoted this idea in the 1980s through the ‘Health for All’ by the year 2000 agenda that came to be popularly known as the Alma Ata Declaration. And the era of health sector reforms that followed this campaign in the 1990s consequent upon the macro-economic adjustment programmes of the IMF and World Bank in many developing countries; also aimed at achieving better healthcare for all. While the debate on how to reach this goal globally has largely focused on further reforms of health systems, especially funding healthcare; little attention is paid to what really matters – outcomes.
No doubt policies on improving financial access to healthcare for everyone that could contribute to improved health status are essential; they are not sufficient on their own to achieve better physical and mental health outcomes across all demographic and socio-economic groups. Experience elsewhere (and even in Nigeria) has shown that to get to this level of change within the health sector, managerial capacity, which provides the link between defined policies and their implementation is crucial.
In the particular context of Nigeria, other than concerns about the ability of individuals and agencies responsible for leadership, planning and evaluation, decision-making and regulation of the health sector; the prevailing political-economy of Nigeria being a federal country (even just in concept), and other factors outside the health sector such as macro-economic performance, infrastructural development, educational levels and cultural norms impose added managerial challenges. Therefore, as the summits, conferences, workshops and seminars in support of universal health coverage rage on, it is important that significant attention is paid to this point. And may be, it is also time to make the complex very simple ◊◊◊