A scholar’s story: How universal is universal health coverage today?

This post is authored by Dr. Bonaventure Dzekem, a medical doctor and entrepreneur from Cameroon who is an Obama Foundation Scholar currently studying at the University of Chicago. The Obama Foundation Scholars program supports dynamic, collaborative, rising leaders from around the world through an innovative one-year academic experience combined with leadership development training that works to equip them with the necessary skills and networks to take their work to the next level. Read Bonaventure’s story:

“Doctor, we have an emergency,” a nurse said on the phone. “A pregnant woman is in labor, but she’s barely conscious.”

I quickly rushed to the hospital. There, I met a 22-year-old lady, covered in mud and semi-conscious. She had been brought from another health center two hours away on the back of a motorcycle because there wasn’t an ambulance available. She had been in prolonged labor for nearly 20 hours. Even if there had been an ambulance available, the surrounding roads were bad, and vehicles could not easily clear a route.

A referral wasn’t initiated until she developed seizures and other complications, so I received the patient with no referral note and no medical records. I quickly took her to the operating theatre for an emergency cesarean section. We saved her life, but sadly, it was too late for the baby. A stillbirth.

Unfortunately, this case wasn’t unique. When I worked as the Chief Medical Officer of a community hospital in Cameroon, I witnessed the preventable deaths that occurred due to negligence and a weak health care system on a weekly, sometimes daily basis. It’s the same for most healthcare workers who practice in resource-limited settings.

That newborn’s death, among many other tragedies from malpractices, could have been prevented. But who is to blame? Is it the government for not providing equipped health facilities in remote areas? Is it the staff at the health center who failed to refer the patient in time? Is it the local council for not providing safe roads? It’s difficult to trace tragedies to one cause, but I would argue it was due to a weak health care system.

How do we define access to strong health care systems? For a successful person in New York City, it could be the ability to have a complex elective surgery performed conveniently. For a subsistence farmer in Akwaya, Cameroon, it could be the ability to have a healthcare facility that provides the most basic primary care services within a reasonable walking distance. Around the world, access to healthcare means different things. These disparities can be observed across different countries and even within the same country. But a common vision is forming.

Universal health coverage (Opens in a new tab) is at the center of current efforts to strengthen health care systems around the world. The United Nations’ Sustainable Development Goals seek to ensure healthy lives and promote well-being for all, with a specific sub-goal that makes a case for universal health coverage.

According to the World Health Organization (Opens in a new tab), at least half of the world's population still does not have full coverage of essential health services and about 100 million people are still being pushed into extreme poverty (Opens in a new tab) because they have to pay for their own health care. Research shows that improved health in low- and middle-income countries can promote economic growth. Thus, implementing universal health coverage will not only promote health but will also contribute significantly to economic development.

Strengthening primary health care has been proposed as an important factor in achieving universal health coverage. But there are two potential obstacles:

First is the power and influence elite urban hospitals and healthcare providers have on policy. There is persistent unequal allocation of resources in low- and middle-income countries, where distribution of supplies to public hospitals is typically politically driven. It’s not uncommon to find an urban health center fully stocked while a rural health center in the same health district, has no supplies.

And second, public hospitals are generally not effective in delivering quality primary care services. Low income and impoverished communities in many countries continue to use more expensive private and specialist health centers, sometimes with unlicensed practitioners in search of better care. Vaccinations, maternity care, oral rehydration solutions, and mosquito nets are often provided through the government, but are underutilized.

To solve both issues and achieve universal health coverage, policy makers must target marginalized regions. They need to ensure equitable distribution, requiring health care systems to prioritize providing primary health care services in rural areas, rather than maintaining specialized services like MRIs and CT scans in urban hospitals that are miles out of reach for the poor. Also, governments should ensure public hospitals implement efficiency and accountability practices for staff management and operations. For far too long, public hospitals have seen poor facility management and low employee attendance without consequence.

Working as a physician in an under resourced community prompted me to establish Keafon Health (Opens in a new tab), an organization aiming to improve access to health care in rural and semi-urban communities. My goal is to understand why health care systems fail and how to improve them, which is why I applied to the Obama Foundation Scholars program. I’m studying international development and policy with a focus on Global Health and Health Systems at the Harris School of Public Policy at the University of Chicago. Through a highly intensive academic program and an extraordinary hands-on leadership and mentorship experience, I’ve been able to acquire the knowledge and skills I need to push my work forward.