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Breaking down the silos of Universal Health Coverage: towards systems for the primary prevention of non-communicable diseases in Africa
  1. Tolu Oni1,2,3,
  2. Ebele Mogo1,
  3. Aliko Ahmed1,4,
  4. Justine I Davies1,2,5,6
  1. 1MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
  2. 2Stellenbosch Institute for Advanced Study, Stellenbosch, South Africa
  3. 3School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
  4. 4Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
  5. 5Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  6. 6Centre for Global Health, King's College, London, UK
  1. Correspondence to Dr Tolu Oni; tolullah.oni{at}

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  • African countries are not on track to achieve global targets for non-communicable disease (NCD) prevention, driven by an insufficient focus on ecological drivers of NCD risk factors, including poor urban development and the unbridled proliferation of the commercial determinants of health.

  • As the risk factors for NCDs are largely shaped outside the healthcare sector, an emphasis on downstream healthcare service provision to the exclusion of upstream population-level prevention limits the goals of universal health coverage (UHC) and its potential for optimal improvements in (achieving) health and well-being outcomes in Africa.

  • The political will for UHC in Africa will miss the opportunity to turn the tide of this emerging NCD epidemic in Africa, if not oriented to a systems for health rather than a solely healthcare-centric approach. A successful approach needs to proactively incorporate wider health determinants (sectors)—housing, planning, waste management, education, governance and finance, among others—in strategies to improve health. This includes aligning governance and accountability mechanisms and strategic objectives of all ‘health determinant’ sectors for health creation and long-term cost savings.

  • Researchers have a vital role to play, collaborating with policy makers to provide evidence to support implementation and to facilitate knowledge sharing between African countries and globally.

The third sustainable development goal (SDG), ensuring healthy lives and well-being for all at all ages, although comprising multiple components, is often strongly linked with the concept of universal health coverage (UHC) and its underlying principles of equity, quality and financial protection. The importance of addressing the upstream determinants of health as a vital accelerator of progress in achieving the SDGs has been recognised1; however, in practice, the implementation of UHC has often been restricted to a disease-fighting, healthcare-centric approach. This constrains the ability to achieve WHO’s definition of health as the attainment of ‘complete physical, mental and social …

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