Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 1 | P a g e c REVIEW ARTICLE Innovative Strategies to Strengthen Health Service Delivery for Universal Health Coverage in Africa – A Scoping Literature Review Mobolaji Modinat Salawu1, Obinna Emmanuel Onwujekwe2, Olufunmilayo Ibitola Fawole1 1 Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria; 2Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria; Corresponding author: Mobolaji Modinat Salawu Address: Department of Epidemiology and Medical Statistics, Faculty of Public Health, Col- lege of Medicine, University of Ibadan, Nigeria; E-mail address: sannibolaji@yahoo.com mailto:sannibolaji@yahoo.com Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 2 | P a g e Abstract African nations have failed to achieve the mandate of health for all forty years after Alma Ata declaration. To achieve Universal Health Coverage (UHC), government alone are unable to solve the problems of health service delivery such as lack of good infrastructure, poor manage- ment, inter-cadre conflicts, lack of skilled birth attendants amongst others. This review assessed the involvement of non-state actors (private sector/philanthropists) in achieving UHC in Africa. We explored eight databases and search engines using specific search terms. We retrieved and conducted a detailed review of 47 publications comprising published literature and reports fo- cused on private sector/philanthropy involvement in achieving UHC in Africa, and explored the challenges and opportunities. We included both qualitative and quantitative studies published in English. Inequity and a wide gap exist in countries’ health care service delivery due to numerous chal- lenges such as chronic economic instability, bureaucracy, poor healthcare financing, corruption among others. Review of existing literature suggests that as Africa embarks on reforms toward UHC there is a great need for involvement of private sector/philanthropists to support govern- ment in addressing challenges facing health care system. The type of involvement revealed were; provision of infrastructure (hospital buildings/facility, good roads), technical support, tech- nological innovations, provision of diagnostic and therapeutic equipment, financial support and other support services. This scoping review showed that private and philanthropist actors’ involvement in healthcare system have huge potentials to improve, restore and maintain health service delivery in African nations. This will accelerate progress towards the achieving UHC by 2030. Keywords: Private, Philanthropy, Health service delivery, Universal health coverage, Africa Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 3 | P a g e Introduction The Alma ata declaration of 1978 identified Primary Health Care (PHC) as the key to at- tainment of the World Health Organisation (WHO) goal of ‘Health for All’ (1). How- ever, forty years after, this declaration is yet to be fulfilled by most countries of the world especially, the African nations. In 2018, the WHO endorsed the Astana decla- ration to renew the commitment to strengthen PHC and achieve a Universal Health Coverage (UHC) which is one of the targets of health related Sustainable Devel- opment Goals (SDGs) (2). UHC is the bed- rock for health-related SDGs to ensure eq- uitable and sustainable health outcomes as well as contributing to other SDGs to en- sure an effective health system (3). UHC is defined as all people having access to qual- ity health services without suffering finan- cial hardship associated with paying for care (4). This means all people and commu- nities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality, while ensuring that the use of these services does not expose the user to financial dis- tress (5). To achieve UHC, six essential health systems attributes are embraced which are reflected in the health policy ob- jectives across regions. These are; quality, efficiency, equity, accountability, sustaina- bility and resilience (6), summarized into three related objectives: (i) Equity in access to health services - everyone who needs ser- vices should get them, not only those who can pay for them; (ii) The quality of health services should be good enough to improve the health of those receiving services; and (iii) People should be protected against fi- nancial-risk, ensuring that the cost of using services does not put people at risk of finan- cial harm (7). The health systems for UHC consists of three pillars which are necessary to improve well-being of the people in Af- rican nations; these are service delivery, health financing and governance (8). In Af- rica, health service delivery is faced with problems of poor management; inter-cadre conflicts; lack of good infrastructure, lack of skilled birth attendants; essential medical commodities and high cost of treatments among others (9). This results in poor utili- zation of health services with poor health outcomes such as low immunisation cover- age, high morbidity and mortality from communicable and Non-Communicable Diseases (NCDs) (9, 10). The government is unable to guarantee availability, accessi- bility, acceptability, and quality of all health-related services for everyone resid- ing on her territory (11). Pregnant women and children are mostly affected by these challenges as evident by the poor health in- dicators reported in the WHO African re- gion. This includes, maternal mortality rate of roughly two-thirds (196 000) of global burden, infant mortality rate six times higher than WHO European region (51/1,000 live births), and rising cases of NCDs (12, 13). Research has documented that some African countries, such as Ghana, Kenya, Morocco, Rwanda, South Africa and Senegal are on the path to achieving some aspects of UHC. These countries have provided insurance coverage for the low-in- come group and improved on access to health care (8, 14, 15). Rwanda and Ghana have progressed the furthest toward achievement of UHC evidenced by im- provement in the country’s health indices (14). However, the progress of most Afri- can nations towards achieving UHC is ra- ther slow (8). In addition, most African countries are yet to adopt the African Un- ion’s Abuja declaration of 2001 which was to increase spending on public to at least 15 % of the government’s budget (16). Insta- bility in governance, lack of political will, financial constraints are some of the other causes of poor health service delivery, which is one of the WHO health systems building blocks. Health service delivery is confronted with challenges which have de- Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 4 | P a g e prived individuals, families and communi- ties, of the people centered care that PHC offers (2). Undoubtedly, government of many African nations are unable to handle health service delivery, hence the need to shift focus from government as major pro- viders and financiers of healthcare to non- state actors (private/philanthropists) for provision of affordable, accessible and quality healthcare. Also, it is important to strengthen the health service delivery with private/philanthropy participation to bring quick progress towards attainment of UHC by 2030. Philanthropy is a strategic private initiative, established on rebuilding the sys- tem and meant for public good. It is an ap- proach for promoting the welfare of others to better humanity especially by generous donation of money to good course (17). The donations aim primarily to promote the eco- nomic development, welfare and health of developing countries. In addition, they refer to transactions which could be in cash or kind that originate from foundations’ own sources, notably endowment, donations from companies and individuals including High Net Worth Individuals (HNWIs), crowdfunding and legacies, as well as in- come from royalties, investments (includ- ing government securities), dividends and lotteries (18). The private sector plays a vi- tal role in most of the world’s health sys- tems. They can be for-profit, not-for-profit, informal, formal, domestic or foreign. Their involvement in health care delivery is usu- ally for a specific goal. The private sector provides a mix of goods and services in- cluding: medicines and medical products, infrastructure and support services, direct provision of health services, financial sup- ports, training for the health workforce and information technology (19). Challenges to appropriate health service delivery Minimum standards are set on health ser- vice delivery in terms of the human re- sources, infrastructure, medicines and health technologies, as well as the way peo- ple are treated when seeking health services (6). However, health service delivery in most African nations have experienced user by-pass basically because of many con- fronting chronic challenges. Hence, Afri- cans are unable to access affordable and quality healthcare. These are discussed in the following paragraphs according to the six WHO Health Systems building blocks to strengthen health systems. 1) Service delivery Availability of a well-maintained health in- frastructure with conducive consulting rooms, equipped emergency rooms, patient wards, ambulance, on-site laboratory, phar- macy services, and information and com- munication technology are essential to a proper health service delivery (20). Poor in- frastructure and access to health care facili- ties is a fundamental weakness of health service delivery (21). Majority of health fa- cilities in Africa lack good road access; consist of poor and dilapidated infrastruc- ture which has facilitated medical tourism (9). For instance, in Nigeria, over 5000 peo- ple leave the country every month for vari- ous forms of treatment abroad and about 1.2 billion USD of Nigerian economy is lost to medical tourism yearly (22) . 2) Health workforce Overtime, health facilities have been grossly understaffed with staff mix that does not meet the population demand. Af- rica nations continuously experience short- age of health care workers due to brain drain as a result of poor wages and staff welfare (23). This has resulted in increased workload on the available staff with associ- ated reduced efficiency and effectiveness, long clinic waiting time and poor staff atti- tude (22). Inter-cadre conflict is another barrier which has rendered the health sys- tem unworkable (13). In addition, many Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 5 | P a g e African nations still lack skilled birth at- tendants who address complications during pregnancy and childbirth, hence the high maternal and neonatal morbidity and mor- tality rates (24). 3) Access to essential medicines Another challenge of health service deliv- ery is the recurrent shortages and weak sup- ply chain of quality essential medical com- modities, such as drugs and equipment in most health facilities in Africa (23). This re- sults in high cost of treatment which the pa- tients could barely afford. Hence, patients are unable to obtain required medication or treatment as and when due. This unavaila- bility and perceived high cost of care with apparent low quality has contributed to low utilization of health facilities in some Afri- can nations like Nigeria (10, 25). 4) Health information systems Health management information system (HMIS) contributes to the production, anal- ysis, dissemination, use of reliable and timely health information by decision-mak- ers and practitioners at different levels of the health system (26). Unfortunately, the national health information system in Afri- can is weak. Implementing HMIS has been difficult because of factors such as poor funding, governance, poor socio-economic conditions, corruption, etc. (27). Most Afri- can nations still operate paper-based system of record keeping which is cumbersome, in- effective and often lead to loss of health in- formation. 5) Leadership/governance Leadership in healthcare system is one of the biggest challenges that hindered ex- pected progress of healthcare interventions in Africa (26). There is poor integration of healthcare programmes due to limited com- munity participation in planning, manage- ment and monitoring of health services. The government of most African nations lack the political will in implementing govern- ment policy and guidelines; there is poor re- source management and corruption (28). 6) Financing Financial barriers to healthcare system re- main a prevalent problem in most Africa nations with high rates of Out-Of-Pocket expenditure (OOP), owing to ineffective national health insurance system. A study found that about 40% of Total Healthcare Expenditure (THE) is made up of OOP pay- ments in most African nations. The average THE in African countries was US$ 135 per capita in 2010 compared to US$ 3 150 spent on healthcare in an average high-income country (29). Poor healthcare financing is a recurring problem and seem to be beyond the capability of governments of African nations, hence the need to maximise the in- volvement of non-state actors in mobilizing resources and providing innovations to sup- port health service delivery towards achiev- ing UHC. This approach has worked in de- veloped countries and some regions in Af- rica with huge potentials in improving, re- storing and maintaining health service de- livery and overall improvements in health outcomes of the people (19, 30). This can be further studied and adapted by other Af- rican countries. Various studies have ex- plored the benefit of private sector in achieving UHC but few studies have looked into private sector/philanthropist participa- tion in optimizing government activities in the progress towards UHC. In this paper, we reported the findings of a scoping re- view which synthesized evidence on healthcare challenges in Africa nations, in- efficiency of African governments and the possibilities and areas of private sec- tor/philanthropists’ involvement in health service delivery on the way to ‘‘achieving UHC in Africa leaving no one behind’’. Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 6 | P a g e Methods This scoping review focused on countries where private actors/philanthropy are in- volved in health care delivery towards achieving UHC in Africa. We retrieved and conducted a scoping review on 47 publica- tions comprising grey, primary literature and reports. We focused on studies from de- veloped and developing countries, espe- cially African nations. We included both qualitative and quantitative studies pub- lished in English. The inclusion criteria were that literature must focus on Private sector/Philanthropy for UHC in WHO re- gions. Search strategy and screening Various databases and search engines were explored such as PubMed, Google, Google Scholar, Directory of Open Access Jounals, Science Direct, Hinari and ResearchGate. Boolean operators were used to make search more specific using strings with combination of terms (Table 1). Titles and abstracts of peer reviewed articles, reports and other grey literatures were retrieved and reviewed. We also searched reference lists of included studies in order to look for additional relevant literature. Results and Discussion From primary searches, 358 published, un- published and grey literature and reports were retrieved. Other sources included technical reports from Governmental and Non-Governmental Organisations (NGO) news article, online magazine, civil society organizations, and book chapters. After ini- tial screening, 47 matched the inclusion cri- teria and were reviewed. The flow chart de- scribing this process is shown in Figure 1. Table1: Literature search terms 1. “private actors” OR “private provider” OR “private sector” 2. philanthropy OR philanthropist OR “philanthropic actors” 3. “Universal Health Coverage” 4. “developing country” OR “low-middle income countries” OR LMIC OR “sub-Sahara Af- rica” 5. “western pacific region” OR “south east asia” OR “region of Americas” OR “european region” OR “eastern mediterranean region” OR “Africa region” 6. challenge* OR threats AND 7. opportunit* OR benefit* 8. #1 AND #2 AND #3 AND #4 AND #5 AND #6 AND #7 Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 7 | P a g e Figure 1: Flow chart showing detailed article extraction and evaluation method We included articles published from year 2000. These studies employed diverse methodological approaches, using a range of quantitative and qualitative methods. To enable an understanding of this concept of private/philanthropy involvement in health care, we first established the outcome and impacts of poor health service delivery in Africa using the health indices. We also stated the causes of these poor health indi- cators which result in high morbidity and mortality. Thereafter, we highlighted the challenges service delivery such as ineffi- ciency, bureaucratic bottle necks, economic instability, lack of political will, and other gaps in health service delivery. Subse- quently, the definitions of private ac- tors/sector and the types; philanthropy and their activities in health service delivery were discussed. We also highlighted some of the agencies that reinforce this sector, di- mensions they take and their mechanism of services alongside corresponding interven- tions. Studies on involvement of private ac- tors and benefits on health care delivery are well represented in literature for both devel- oped and developing countries. However, the few studies conducted on Philanthropy actors revealed that the aids and grants awarded to nations contributed immensely to the health system growth of such nations. We also found studies that discussed the risks associated with involvement of private actors in health care delivery especially the for-profit private sector. However, the ad- vantages far outweigh the risks which could 180 identified unique articles were scrutinized A total of 358 full text articles pub- lished between 2000 and 2020 were assessed for relevance eligibility 178 articles were ex- cluded for irrelevance and duplication A total of 133 articles were excluded after screening titles and ab- stracts for relevance 47 full text articles were re- viewed for focus and coverage of developing countries Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 8 | P a g e actually be controlled by instituting policy and guidelines for the operationalization of private actors. Some of the reviewed litera- tures are listed in Table 2. Evidence of best practices with pri- vate/philanthropist participation in health care delivery The involvement of non-state actors in health service delivery is not a new phe- nomenon globally, especially in developed countries where it contributes to the growth and success achieved in their health sector (30). This participation as a comparative advantage, such as infrastructural develop- ment, technological innovation, training of healthcare workers, provision of health re- lated services, manufacture of materials and technologies used in health care provision; and financial support which the government can leverage upon (7). Private sector involvement Private actors in health care delivery can ei- ther be for-profit or not-for-profit organisa- tions. They are important stakeholders in any country’s healthcare delivery as they cushion, complement and assist the govern- ment in strengthening the healthcare system (31). They are found in situations and com- munities where governments presence and activities are weak in terms of infrastruc- ture, personnel, finance, commodities and when public facilities are closed or on in- dustrial strike (30). The for-profit private actors such as big corporate hospitals are able to mobilise substantial private financ- ing for expensive medical equipment and technology such as those used in advanced treatments of cancers and cardiovascular diseases (32). The non-for-profit private ac- tors such as Medicines San Frontiers (MSF) known to have more experience and better resources, are quick to mount emergency epidemic and disaster responses compared to the government. In addition, Marie Stopes International, with highly experi- enced staff who are experts in family plan- ning services work in different countries to ensure regular access to family planning products and commodities (32). Both for- profit and non-profit private actors provide a mix of goods and services including: di- rect provision of health services, medicines and medical products, financial products, training for the health workforce, infor- mation technology, infrastructure and sup- port services (e.g. health facility manage- ment) (7). Consequently, most countries operate “mixed health systems”, where a mix of public and private providers deliver health-related goods and services (7, 33). Research showed that among 27 high-in- come countries, 21 have their primary health care delivered by the private sector (33). Grepin in a household survey in 70 low- and middle-income countries, reported that private services provide about 65% of care for childhood illness, but the propor- tions varied widely by country (34). Be- tween 2007 and 2008, the International Fi- nance Corporation found that in Africa, the private sector already delivered about half of Africa’s health products and services (35). This was as a result of the perceived lack of efficiency, quality in the provision of public health care and largely from in- creased costs with reduced budgets for health care due to the financial crisis expe- rienced during the period. A report by the African Development Bank highlights that Africa’s private sector accounts for over 80% of the total production, 65% of total investment, and 70% of total credit to the economy, and employs 90% of the working age population (36). In 2005, of the total health expenditure of $16.7 billion in sub- Saharan Africa, about 50% were captured by private providers (36). It is thus becom- ing important to engage the non-state actors in enhancing the services of the public sec- tor. In Uganda, the United State Agency for International Development (USAID) se- cured the private sector’s role towards the costs of HIV service delivery through a counter-part funding scheme that enabled for-profit clinics to commence provision of Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 9 | P a g e HIV services in 2009 (37). USAID pro- vided medical equipment and health work- force trainings thereby expanding the na- tional network of HIV treatment sites across Uganda especially in parts of the country where government presence was particularly weak (38). The assessment of private sector activities in Uganda was said to be too important to be ignored in attain- ing UHC (39). Table 2: Summary of papers reviewed Sector Challenges of health care de- livery Authors that elaborated on interven- tions Private Service delivery (Infrastructure, medical, laboratory services and equipment, technological innovations) A. Hallo de Wolf and B. Toebes (2016), WHO 2018, D. Montagu and C. Good- man (2016), D. Clarke et al (2019), K. Grepin (2016), International Finance Corporation (2007), M. Baig (2014), R. Brugha and A. Zwi (2002), R. Kumar (2019) Health workforce (technical ex- pertise) USAID (2013) The health initiatives for the private sector (hips) project final evaluation report, D. Montagu and C. Goodman (2016), H. Zakumumpa (2016), Africa Healthcare Federation, 2020 Finance (financial support) International Finance Corporation (2007), S. Basu (2012), World Bank (2016) Uganda Private Sector Assess- ment in Health, M. Baig (2014), S. Pour Doulati et al (2011), O. Olu et al (2019), P. Bakibinga et al., (2014) Access to essential medicine (medicines, medical products) S. Pour Doulati (2011), B. Uzochukwu (2015) Health information systems D. Clarke et al (2019), WHO (2018), R. Kumar (2019) Philanthropy Service delivery (infrastructure, medical, laboratory services and equipment) OECD netFWD. (2019), Africa Healthcare Federation, 2020, S. Basu (2012), B. Uzochukwu (2015), Africa Portal. (2018), University of Ibadan. (2020). Otunba Tunwase National Pae- diatric Centre, P. Bakibinga et al (2014) Finance (financial provision/do- nations) United Nations. (2019). Inter-agency Task Force on Financing for Develop- mentOfficial development assistanc, OECD netFWD. (2019), Africa Portal. (2018), M. Sulek (2009) Access to essential medicine (provision of essential medi- cine) Alliance Magazine. (2018), University of Ibadan. (2020), F. B. Dennis. (1993) Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 10 | P a g e Research from Southeast Asia, middle east and some African countries have reported rewarding experiences from government and private engagement. Improvement was seen in the areas of infrastructure, labora- tory services, equipment and supplies which resulted in affordability and patient satisfaction (40, 41). Better performances in the maternal and child healthcare utilization was observed as a result of improved infra- structure and supplies (15). Evidence from Islands of Cabo Verde showed that pri- vate/philanthropist involvement produced positive health outcomes through techno- logical innovations like telemedicine to bridge the gap in human resource and ser- vice shortfall (23). Governments of African countries can leverage upon some of these existing services for continuity while the non-state actors continue to execute impact- ful activities in strategic areas of health ser- vice delivery. Private sector participation in health service delivery is not without risks and concerns such as quality of ser- vices they provide, pricing among others (42). However, the benefits outweigh the risks which can be managed by all the par- ties involved with well-established regula- tions and guidelines. The WHO as a gov- erning body can help to support countries to develop policy guidelines and monitoring tool for managing private/philanthropy and government activities. Philanthropic involvement Philanthropy donations aim primarily to promote the economic development, wel- fare and health of developing countries (18). These donor funding from govern- ment could be in form of loans or aids grants from donor countries who contribute a target of 0.7% of their gross national prod- uct as Official Development Assistance (ODA) to developing countries (43, 44). Philanthropic actors have contributed enor- mously to healthcare on various programs to combat diseases as well as deliver health interventions in developing countries. Be- tween 2013 and 2015, international philan- thropists contributed USD 12.6 billion to reproductive health as well as to combat AIDS, Tuberculosis and Malaria. The top five foundations that provide 87% of fund- ing in health and reproductive health glob- ally include; Bill & Melinda Gates Founda- tion BMGF (72%), the Susan Thompson Foundation (5%), the Children’s Invest- ment Fund Foundation (4%), Wellcome Trust (3%), and Bloomberg Philanthropies (2%) (18). Evidence showed that philan- thropic donation is concentrated in Africa and Asia. According to geographical allo- cation of giving, the top 25 foundations tar- get India (USD 679 million), Nigeria (USD 511 million), Ethiopia (USD 268 million), Pakistan (USD 208 million) and Mexico (USD 144 million). Between 2013 and 2015, Africa received 24% of philanthropic funds for health and reproductive health, and Asia received 13%. The funding went into reproductive health/family planning for Ethiopia (USD 89 million) and infec- tious disease for Nigeria (USD 310 million) (18, 45). Most of these foundations channel their funds for health through intermediary organisations such as NGOs, civil society, multilateral organisations, universities and research institutes. Indigenous foundations also contribute to healthcare development in Africa through local foundations, com- munity groups, and wealthy individuals. A formal structure of philanthropy which in- clude foundations and trusts was set up by HNWIs and charitable organisations with distinct objectives relating to African devel- opment (46). Well-known foundations by HNWIs include, the Aliko Dangote Foun- dation in Nigeria, Nicky Oppenheimer Brenthurst Foundation in South Africa, and the Chandaria Foundation in Kenya, while charitable trusts and vehicles that promote philanthropy include the Southern African Trust, and the Ghana-based African Women’s Development Fund (46). The performance of private and philanthropy https://www.alliancemagazine.org/feature/big-philanthropy-and-policy-change-in-africa/ https://www.alliancemagazine.org/feature/big-philanthropy-and-policy-change-in-africa/ Salawu MM, Onwujekwe OE, Fawole OI. Innovative Strategies to Strengthen Health Service De- livery for Universal Health Coverage in Africa – A Scoping Literature Review. (Review Article). SEEJPH 2021, posted: 27 April 2021. DOI: 10.11576/seejph-4384 11 | P a g e actors in health care delivery is resourceful in ensuring improvement in the area of quality health care, equity of access and ef- ficiency of services which catalyses gov- ernment activities and achievement. This can be in the aspect of financial support to increase funds for health to meet up with in- ternational standards. In addition, prioriti- sation of PHC, increasing funding to rural poor especially by redistributing resource allocation between levels of care for pre- ventive and promotive care (30). Discussion This scoping review has identified various challenges hindering provision of quality healthcare in African nations, most of which are recurrent and implicated in the slow progress towards attainment of UHC. Government of African nations have failed in their responsibility to provide quality, af- fordable and accessible healthcare for their citizens. The health system therefore re- quires support from private sector/philan- thropy which have become important sources of health care provision for devel- oping nations. The benefits of private/phi- lanthropy participation in health system de- livery are enormous and have helped in de- livery of quality healthcare with improve- ment in health status of the people. Suc- cesses reported in the health system of high income countries are as a result of the major contributions of private sector/philanthropy in their health care delivery (18). This in- variably contributed to the excellent health system, best quality of life and good health indicators experienced in developed coun- tries. In essence, health care delivery in Af- rican nations may not survive without assis- tance from non-state actors (7, 47). Some African nations have been supported by pri- vate sector/philanthropy both from external and within the African nations with health care interventions to combat health prob- lems such as infectious diseases e.g. ma- laria, HIV/AIDS, tuberculosis; non com- municable diseases and reproductive health issues (18, 36, 46). This has contributed im- mensely to the improvement in healthcare system in the supported nations. It is there- fore important for governments of African nations to strategically optimise the in- volvement of private/ philanthropist actors in mitigating the challenges of health ser- vice delivery. This will go a long way to re- store, improve and maintain health service delivery of African nations; thereby accel- erating the progress towards attainment of UHC by 2030. Acknowledgements We acknowledge the contribution of Drs J.O Akinyemi, S.A Adebowale, S. 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