Expert insight

Five questions to …. Dr. Angela Gichaga

23 September 2019
  • Angela Gichaga

As world leaders meet at the United Nations General Assembly to discuss the “Universal Health Coverage: Moving Together to Build a Healthier World” which aims to accelerate progress toward universal health coverage, Dr. Angela Nyambura Gichaga, Chief Executive Officer, the Financing Alliance for Health (FAH) explains how partnerships can help governments make the most of existing resources, increase domestic commitments, and identify new financing options to improve access to primary care.

Where does Financing Alliance for Health’s work it into the very wide UHC agenda?

Investment in community health workers is essential to achieving UHC.  Over $3 billion is needed each year to support community health in Africa but only a fraction of that is available. There is a $2 billion funding gap annually, with significant fragmentation in the existent limited funds.   In the recent past, “traditional donor support” is flattening and is insufficient for building strong health systems, on its own – it needs to act as a catalyst to leverage private and public resources in supporting a shift from ‘Billions to Trillions’.

As a partnership, FAH aims to support governments design and fund ambitious, highly effective, affordable, and at-scale primary health systems, as a building block to UHC.

Our initial focus is on community health systems within Africa. We strongly believe that community health workers are a key component of the continuum of care within the larger primary healthcare system. We collaborate with governments to make the most of existing resources, increase domestic commitments, and identify new financing options.

What are your expectations for the UN High-Level Meeting on the UHC and the high-level dialogue on financing for development (FfD)?

Our hope is that the commitments agreed will set the “UHC train” firmly on course to achieve UHC in our generation.

We want three key areas of support recognized to ensure financial resources are put where they are needed.  First, a clear commitment to scale up fiscal spending on health. Second, we would like further measures taken to ensure the efficient use of available funds. And finally, beyond this September, we hope to see government accountability in delivering UHC. This is what we call the SEA framework – e.g. scale-up, efficiency accountability. This framework will help countries identify how they rank on the SEA scale and determine what levers can be deployed to bridge gaps. Empowering citizens with data on health allocations and spending via citizen platforms will allow them to hold their government and officials accountable and make their voices heard.

We continue to support the discourse on translating political will into action, through financial commitments from varied stakeholders. In August, we launched a new platform for dialogue, bringing together global and regional health funding enthusiasts to foster discussion and stimulate innovative collaborations on health investment and how to achieve UHC.

How does Financing Alliance for Health help to ensure access to primary care, especially in developing countries? What are the main challenges?

Qualified community health workers play an important role in increasing access as well as coverage of essential healthcare interventions, while making health systems more resilient. They are embedded in the communities they serve.

FAH supports governments design and fund ambitious, affordable, and at-scale community health programs, including via innovative financing pathways and investment opportunities that involve the private sector.  Thanks to strong partnership with governments across Africa, we have shown how countries can build costed investment plans for their national community health workers programs.

One challenge is that all too often, health plans are considered the responsibility of a single government entity: the Ministries of Health. However, at scale, community health programs are a health, social as well as a development agenda. Not only do these systems improve health indicators (as part of the larger health system), but they also result in increases in a country’s GDP while creating employment opportunities for previously disadvantaged groups.

While the Ministry of Health is the key technical partner in the design of a highly effective program, the Ministry of Finance is the “government’s purse string” and is the custodian of vital resources to facilitate implementation. Moreover, other line ministries may have a crucial part to play as part of the wider development agenda. Given that there seems to be lack of good alignment in the language spoken between these 2 key ministries, our role as FAH is to facilitate the conversation through comprehensive investment plans and resource mobilization. Our goal is to bridge the gap in communication, understanding and collaboration (with multiple stakeholders), so that we can plug the gap in funding.

Can you point to successful financial strategies directed at community health workers?

Success for us is clear: how we can contribute to reducing the $2 billion annual gap in funding by supporting governments develop country specific investment plans that can be funded through contextualized financing sources. Our robust investment plans and financing pathways provide a platform for increased investment.

We have advised, collaborated, developed tools and/or codified experiences in several countries in sub-Saharan Africa, including but not limited to Liberia, Sierra Leone, South Africa, Uganda, Rwanda, Togo, Zambia, Zimbabwe.  We have supported governments, directly and through partnerships, to focus ~$30 million to community health strategies deploying ~20,000 community health workers across different countries.

Through our analytical toolkits, we can identify the resource needs, return on investment and cost savings of the proposed programs. In addition, to supporting governments with their resource mobilization, our team has developed the Community Health Financing Compendium, collating available financing instruments and approaches and acting as a “one stop shop” for governments on funding/ financing options available to them, while guiding them on selection and utilization.

What is the role of the private sector in helping achieve UHC?

Delivering high quality, accessible primary healthcare is a great stepping-stone towards making UHC a reality in our time.  The private sector continues to be a point of access for a significant proportion of patients. This sector has demonstrated its comparative advantage in terms of efficiency, innovation and quality.

The private sector has a role to play in providing basic health services, but for this to happen governments need to put in place structures and incentives to allow for equitable involvement of the private sector.

New and innovative collaborations should be explored and put into place. We need to build on the traditional partnerships and explore multi-sectoral models such as People -Public-Private- Philanthropic funded collaborations.

Global Health Matters editor: For further reading on this topic, see “Achieving a Healthier and More Sustainable Future for All – Policy Perspectives on Universal Health Coverage from the Innovative Biopharmaceutical Industry”. This was published on 17 September 2019.


  • Angela Gichaga