Why healthcare equity should be prioritised

Celebrated on April 7, this year’s World Health Day carried an imperative message of fostering health not as a privilege, but a right for all. Interestingly, it coincided with the Kabaka Birthday Run, a monumental health promotion event in Buganda, this time focusing on HIV awareness.

It was grounded in encouraging men to lead in stopping further transmission, advancing the global agenda to achieve zero infections by 2030. By comprehensively mobilising and educating people about their obligations in the fight against HIV, it signalled the efficacy of collaborative participatory health promotion in hastening health for all.

It is hence only viable to replicate such activities in regions experiencing sub-optimal health outcomes like West Nile and Busoga.

As reflected by above national average rates of child, infant, and maternal mortality, teenage pregnancy, and gender-based violence, in the 2022 Uganda Demographic and Health Survey (UDHS) report, such regions are more exposed to health disparities and associated bearings.

With about 50 adolescents getting infected by HIV every day, as indicated in the 2023 World Aids Day report by the Uganda Aids Commission, there is a justifiable need for equitable health promotion programmes to intensify health education for such vulnerable groups. It warrants intentional commitment to inclusive preventive care, a proven pathway of minimising the spreading of diseases and ultimately reducing the burden on the already constrained resources earmarked for curative and rehabilitative care. While at this, embracing emerging innovations would further enhance programme spread. For instance, encouraging digital health would boost remote screening, self-testing would resolve issues of physical inaccessibility to health centres, and personalised care, which allows patients’ proactive contribution to care plans would lessen unnecessary and sometimes expensive diagnoses and treatment.

Additionally, inclusively empowering people through health education can amass acceptance for life-saving programmes like immunisation, currently being threatened by growing hesitancy. The 2022 UDHS reports that about 46 percent of children country wide did not receive basic vaccines.

While this could be largely due to structural setbacks, vaccine hesitancy cannot be ruled out.

Lastly, health promotion can be used to mobilise private health financing at community level, especially at a time as this where the county is yet to achieve the 15 percent health budget allocation recommended by the Abuja declaration. While the national health policy is grounded in improving the reach of health services through universal health care using the minimum healthcare package, implementation is dependent on financing. By mobilising communities to adopt more attainable approaches such as community-based health insurance schemes, more people can be reached with quality, effective and affordable care. Unlike the currently proposed national health insurance model which largely accommodates the elite middleclass, the former enables even the less privileged like the urban poor to access healthcare.  

Therefore, we cannot continue to assume progress in realising health as a right for all, by merely being party to binding international conventions and celebrating isolated success while some regions constantly grapple with health services inequity, undernutrition, floods, environmental pollution and a food ecosystem where sometimes residues of pesticides find their way in people’s plates.

There is a need to shift resources from over concentration on curative structures to an equitable health promotion approach, that prevents the occurrence of diseases. We need to impartially reach all people regardless of their location and status with reliable pertinent information in ways that they understand, to enable them to participate in making informed decisions about safeguarding their health.

Ms Irene Jean Kagogwe is a public health consultant at Qstats Health Consulting Uganda. [email protected]