How community members and structures can contribute to Universal Health Coverage (UHC)



Elizeus Rutebemberwa

Universal health coverage aims at providing essential quality health care to everybody at affordable cost. People are seen as consumers and health care is seen as a service for which payment has to be made. To increase coverage, government has increased the number of health facilities in an effort to decrease the distance that people need to walk to health facilities but also added on Community Health Workers (CHWs) also called Village Health Teams (VHTs) to bring health care services within the community. This is commendable. However, building more health facilities or recruiting VHTs is more of multiplying the distribution centres for the health care (a service) that the patient (a customer) is to procure. This is the supply side. Sometimes patients do not utilize these services however close they are. Patients need to effectively demand the services. There are community structures which can be used to support UHC in promoting effective demand.

Beyond the individual and household, there is another key partner in the health care seeking – the community to which the sick person belongs. These are what some authors have called the significant others. They will be the ones who will interpret the symptoms and direct the person to where the best services could be got. They will be the ones who will support the sick person in his or her sickness. An elder sister may have to go with an expecting mother. The husband has to mobilize funds for the wife. A mother-in-law may be consulted on the best midwife to go to for delivery. A younger sibling has to come to stay at home while the woman is away. An entire team has to be assembled to keep the essential functions of the family moving.

This process should be supported in helping the person to seek care. It is a process that looks at a patient not as a biological organism whose physiological functions are malfunctioning and need to be corrected by a medical intervention but rather as a social human being who has a family, needs funds for treatment and support while at the hospital, has young children to look after and needs information on where to seek care. This is the work of the community to which the sick person belongs and the community has put there structures to fulfil these functions.

If men are the ones to support their wives to go to hospital, support the men in this endeavour by helping them to save, let them form saving groups to support their wives. They will gladly do it because it is their role. If mothers-in-law are the significant others in whom their daughters-in-law will confide as to places to deliver from; meet the mothers-in-law so that they analyse the challenges of delivery and how they can support their daughters-in-law. If the educated children in the village are consulted on where the community members need to seek care from, give them a forum to talk to the community on appropriate places to seek care from. Creating effective demand is necessary if patients are to receive the quality affordable care. There is need to build on community structures to obtain this demand and complement government efforts towards UHC.


The author is Associate Professor of Health Systems at Makerere University School of Public Health