The Amaka Chiwuike-Uba Foundation (ACUF) is organizing the 2023 Amaka Chiwuike-Uba International Asthma Conference (ACUBIAC 2023) for stakeholders in the health and financial sector to brainstorm on health financing and universal health coverage. ACUBIAC 2023 is the third in the series of international advocacy and public-private dialogue for better health sector environment.

The international asthma conference, with the theme “COVID-19 and the Future in the Past: Health Financing and Universal Health Coverage in Africa”, is scheduled to hold at Oaklands Hotel & Amusement Park in Enugu on Thursday, July 20, 2023, with former minister of health, Professor Isaac Folorunso Adewole, as Chairman of the conference.

Other speakers at the conference include President, Nigerian Medical Association (NMA), Dr. Uche R. Ojinmah; Professor of Health Economics, Systems and Policy, Professor Obinna Onwujekwe; President, Global Allergy & Airways Patient Platform (GAAPP), Tonya Winders; Paediatric Pulmonologist, UNTH, Enugu, Dr. Adaeze Ayuk; Economic Consultant and former SA to the President on National Development Matters, Ifediora C. Amobi, Ph.D; and Leadership Consultant and Founder Human Rights Volunteer Corps, Larry Oguego. The President, Nigerian Thoracic Society (NTS) and other dignitaries will also be in attendance.

ACUF partners for the conference include: Nigerian Medical Association, Global Allergy and Airways Patient Platform (GAAPP), Nigerian Thoracic Society (NTS), Little Lung Africa, Knowledge and Policy Management Initiative (KAPOMI), ACUF Initiative for Policy and Governance (AIPG), Diocese of Nike (Anglican Communion), and Human Rights Volunteer Corps.

In a concept note presented by the Chairman of the Board, Amaka Chiwuike-Uba Foundation (ACUF), Chiwuike-Uba, Ph.D, he revealed that the conference will stimulate dialogue and collaboration among stakeholders on health financing and UHC. In particular, to secure financial and political commitments to increase prioritize, increase and sustain funding as well as improve the effectiveness and efficiency of investments/financing in the health sector and access to quality and affordable healthcare in Nigeria.

He said the conference will ensure accelerated progress towards universal health coverage, including access to essential health services, accelerated and scaled up action on Noncommunicable Diseases (NCDs), to meet global targets to reduce the number of people dying from NCDs like asthma, diabetes, cancer, heart and other lung diseases.

He added that the conference will raise awareness among policy makers and other stakeholders to the importance of and the opportunity health financing and public spending on health play in creating stronger, more resilient health systems in Africa and why additional attention to and resources for this issue are urgently needed;

Furthermore, Uba said the conference will lead to the exchange of knowledge and practical experiences in delivering quality, affordable, equitable and sustainable health care services in resource-constrained environments through innovations (efficient medical devices) and financing/delivery models, apart from providing building a coalition in support of national and global action on health financing and universal health care coverage and delivery.

He said: “The COVID-19 pandemic has not only exposed the weaknesses of health systems and resilience in Africa, but also exposed areas of need, provided opportunities to strengthen Africa’s health infrastructure and confirmed the need to mobilize resources and secure public funding for health spending. It has also provided the framework to recognise the critical importance of universal systems to galvanize progress towards universal health systems, by capitalizing on the current political commitment to address health emergencies.

“One of the major problems facing Africa; especially Nigeria is the lack of healthcare structures, materials and health care workers, archaic methods, poor health care financing, poor/low health care services, and the inability to build upon lessons learned. These problems persist despite the recognition of the right to life as a fundamental human right of all human beings, by the Constitutions, international charters, commissions and conventions and most recently, the SDGs. Specifically, SDG 3 has an overarching objective to “ensure healthy lives and promote wellbeing for all at all ages”. Nevertheless, the achievement of the remaining 16 SGDs rests squarely on the achievement of SDG 3.

“According to the World Health Organisation (WHO), over 920 million people spend at least 10% of their household budget on out-of-pocket expenditures on health care, and about 100 million people are still pushed into extreme poverty because they have to pay for health care. In Africa, approximately one in three people (33% of the population) currently has access to essential health services under the available health systems, while the remaining 67% of the population does not have access to essential health services.

“In addition, about 38% of Africans delay or forgo health care due to high costs, even when the continent is carrying 23% of the global disease burden, with lower respiratory diseases (including asthma) as one of the highest six major diseases. According to the 2020 Global Spending on Health Report, Africa’s health expenditure in 2018 accounted for just 1% of total global health expenditures and the rest of the world spends 10 times more on health care than Africa. Evidently, increased public spending on health and investment in stronger health systems is crucial in ensuring universal health coverage (UHC), while responding to COVID-19, protecting people from future health threats and making health for all a reality.

“In Nigeria, the profound lack of recommended asthma medicines in pharmacies is worrisome. In most cases, the available medicines, such as oral corticosteroids, have multiple adverse side effects. The oral salbutamol formulations also are associated with side effects such as tremors and cardiac arrhythmias and may promote recurrent exacerbations and the risk of asthma mortality. Unfortunately, these oral formulations are on the Nigerian EML which is clearly out of tune with the current recommendations by WHO. None of the medicines that are the mainstay of treatment for asthma is available in Nigeria.

“The drivers for the high availability of oral salbutamol and other non-guideline recommended treatment for asthma in Nigeria may be related to the poverty, poor knowledge and non-application of guideline-based care among doctors who continue to prescribe these medications. Due to the lack of access to asthma medications in Nigeria, occasioned by availability and affordability issues, the level of asthma control in Nigeria is poor with a high burden of asthma symptoms, limitation in activities and mortality.

“Understanding that the UHC is the bedrock for resilient health systems, which will remove financial barriers to accessing primary health care, particularly for the poor and vulnerable, all the United Nations Member States agreed to achieve universal health coverage by 2030, as part of the SDGs. The SDG 3.8 aims to achieve universal health coverage, including financial risk protection, access to quality essential healthcare services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all. Also, SDG 3.4 aims to reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

“To achieve this, while the Addis Ababa Action Agenda underscored the need for the mobilization of private-sector finance and domestic public resources, the Abuja Declaration had all the African Union countries pledged to spend at least 15 percent of their annual national budget on health. Painfully, despite the above agreements, public spending on health has remained abysmally low, with the exception of Tanzania that has achieved the target of 15% of the total annual budget on health. For other countries, the share of government expenditures going to health is even reducing compared to the position prior to the Abuja Declaration. Health budget outturn in terms of actual spending and achieving key budget objectives is even worse than the budgeted amount.

“Africa’s public spending on health remains inadequate to meet the annual health financing gap of about US $66 billion, as well as the rising health care demands. Increasing public debts may not be the option as most African economies are currently spending up to five times their health budgets on debt repayments.

“Therefore, to bridge the financing gap and increase access to affordable and quality health care in Africa, a policy to expand universal health insurance coverage and leverage the capital and capacity of the private sector to complement government financing and investments is needed. Primary Healthcare (PHC) as the main enabler of UHC and poverty reduction requires huge investment in health facilities, equipment and infrastructure, human resources (including e-learning) and e-health tools to improve access and quality of health service delivery to the poor and vulnerable populations.”

He added: “In Nigeria, PHC is very weak and one of the main foundations and drivers of gross inequality in health status of people. Many perceive health as a non-productive sector, one which does not contribute so much to growth and development. However, available data have shown that health is a very productive sector for investment. According to Nigeria’s government, Nigeria alone is losing $1bn annually to medical tourism and Africa’s health care market is worth over $35 billion. This is even more given Africa’s population growth rate.

“Nigeria is reported to have about 40,400 hospitals and clinics, with 34,385 representing 85.1% of the total hospitals and clinics as PHCs. While about 12% of the total practicing physicians work in the 34,385 PHCs (public and private), 74% work in private hospitals and 26% in public hospitals. Conversely, while a larger percentage (74%) of the practicing physicians works in private hospitals, private hospitals and clinics represent only 27% of the total hospitals and clinics in Nigeria. In summary, Nigeria has 1 physician per 2500 population and 1 nurse per 625 populations.

“Since the formal launch of the NHIS on June 6, 2005, government spending on health as a percentage of the total budget has continued to decline, with less than 3 percent of Nigeria’s population covered by the scheme. In 2020, government spending as a percentage of health spending was only 14.9%, with out-of-pocket expenditure accounting for 74.7%, health priority 4.2%, external aid 6.9% and health insurance 0.76%.

Furthermore, he said: “There can be no UHC without affordable, quality, equitable and sustainable primary healthcare, supported by health financing. Therefore, increased public spending, private sector investments, and universal health insurance are panacea to achieving universal health coverage – managing health inequalities and risks for the poor, vulnerable and marginalized populations as well as reduction in poverty and avoidable annual deaths and morbidity.

“Therefore, in realization of and on the need to address these key components of healthcare systems and management; especially health financing and universal health coverage, the theme for the 2023 Amaka Chiwuike-Uba International Asthma Conference has been chosen as “Future in the Past: Health Financing and Universal Health Coverage”.

“The overreaching goal of the Conference is to provide a platform/forum to identify, brainstorm and share information on Health Financing and Universal Health Coverage as well as stimulate dialogue and enhance collaboration among stakeholders for more effective public, private and external investments and financing of the health sector, with a view to urgently accelerate progress towards health SDGs and achievement of UHC by 2030.

“The one-day interactive Conference will adopt a hybrid format (on-site and online) and will be divided into three sessions. “The Conference will bring together local, national and global experts and organizations in the public and health finance, including Ministries of Health, Finance and Planning, Environment, Education and other national and sub-national government representatives; multilateral and bilateral development partners and foundations.

“In particular, the participants, which are expected to be over 1000 persons, will include the members of the legislature, the executive (key policy and decision makers who have the powers to put policies and programs into action), medical practitioners, civil society organizations, non-governmental organizations, academia, professional associations and the private sector and broader communities.”

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