Uganda + 2 more

Reinforcing locally led solutions for universal health coverage: a logic model with applications in Benin, Namibia and Uganda

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Joël Arthur Kiendrébéogo, Andrea Thoumi, Keith Mangam, Cheickna Touré, Seyni Mbaye, Patricia Odero, Edward Owino, Claire Jones, Grace Ssali Kiwanuka, Zilper Audi, Danielle Bloom, Amelia Kinter, Allison Gamble Kelley


Development assistance for health programmes is often characterised as donor-led models with minimal country ownership and limited sustainability. This article presents new ways for low-income and middle-income countries to gain more control of their development assistance programming as they move towards universal health coverage (UHC). We base our findings on the experience of the African Collaborative for Health Financing Solutions (ACS), an innovative US Agency for International Development-funded project. The ACS project stems from the premise that the global health community can more effectively support UHC processes in countries if development partners change three long-standing paradigms: (1) time-limited projects to enhancing long-lasting processes, (2) fly-in/fly-out development support to leveraging and strengthening local and regional expertise and (3) static knowledge creation to supporting practical and co-developed resources that enhance learning and capture implementation experience. We assume that development partners can facilitate progress towards UHC if interventions follow five action steps, including (1) align to country demand, (2) provide evidence-based and tailored health financing technical support, (3) respond to knowledge and learnings throughout activity design and implementation, (4) foster multi-stakeholder collaboration and ownership and (5) strengthen accountability mechanisms. Since 2017, the ACS project has applied these five action steps in its implementing countries, including Benin, Namibia and Uganda. This article shares with the global health community preliminary achievements of implementing a unique, challenging but promising experience.

Summary box

  • Technical assistance to low-income and middle-income countries in the health sector often takes a top-down approach, coming as a prepackaged set of activities that stifles programme co-design and local capacity building in a way that skirts real country needs and hampers local ownership.

  • Innovative approaches are needed to equip local communities and governments with the required skills and resources to put countries in control so that local actors can steer their own universal health coverage (UHC) processes and maintain responsibility to move them forward.

  • Experience from three countries in sub-Saharan Africa suggests processes focused on promoting demand-driven knowledge exchanges and learning, multi-stakeholder and sectoral collaboration, and accountability mechanisms hold great potential to help overcome obstacles in progressing towards UHC.

  • Supporting change is a long-term endeavour, and broad support from all stakeholders is essential for a real paradigm shift in donors’ relations with their country counterparts, for effective and lasting results.