In Africa, most of the health facilities are concentrated in the urban and surrounding areas and generally leave out the rural areas. Unfortunately, too these areas are also left out when emergency rescue services set ups are considered. These two scenarios have had negative impact with increased mortality rates especially when there has been an emergency, whether of a sudden disease or a hazard such as a fire or other catastrophe. In some cases, child mortality and mother-child mortalities could have been avoided.
Discussing the impact of distance of health facilities to actualization of UHC, Jayesh Saini said a country cannot purport to have attained UHC if people are travelling more than 5 kilometres to receive the required medical attention, especially primary healthcare. He indicated that such facilities are also owned mostly by private investors and may not even be covered or recognised for the national social insurance. This means that any person seeking services in such facilities would need to pay out of pocket unless they have private insurance, which is very unlikely.
This kind of a situation shows that not only is it critical for governments to solicit for funds to pay for the health services but must at the same time ensure there are health facilities even to the most remote parts of their countries for people to access services without having to travel for hours, sometimes for days. Having facilities near the people also allows for quicker recognition of an outbreak and faster interventions to contain the spread, reduce fatalities and severity of the disease. Ministries of health rely on data collected at facilities for policies and development agendas. Without such consistent data, some regions can be side-lined and bypassed with the notion that the populations are too low for some interventions.
With reduced distribution of health facilities authorized to provide care by the governments, as one travels from urban to rural areas, there is possibility for increased failed healthcare and thus poor accessibility to services when required. To narrow this gap, government facilities should be set up. If this is not possible, the governments should introduce incentive to encourage the private players to set up facilities in such areas. Some of the incentives would include priority to enroll them as service providers for the government schemes, provide payment amounts that help them remain in business, especially considering that some of these areas have small population and would otherwise not make economic sense and yet require the services. An alternative measure would be to provide mobile clinic services with strategic stop over points being clearly identified within easy reach of the populations. This would compensate the shortage of clinics and ensure services are delivered and health records are kept. Observations would also be easier if there was any change in the areas. In Kenya this would be in line with one of the requirements that clients/members of NHIF require of the Fund – to ensure geographical spread of services.
